[PHNUTR-L] What Is the Role of Food Allergy and/or Intolerance in the Genesis of IBD?

[Kathrynne Holden, MS, RD]

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What Is the Role of Food Allergy and/or Intolerance in the Genesis of IBD?
http://www.medscape.com/viewarticle/522393?src=mp

Question

In your clinical experience, what is the role of food allergy and/or 
intolerance in the genesis of inflammatory bowel disease (IBD)?
Expert Response from  Sunanda V. Kane, MD, MSPH, FACG
Associate Professor of Medicine, Pritzker School of Medicine, Chicago, 
Illinois; Assistant Professor of Medicine, Section of Gastroenterology 
and Nutrition, Department of Medicine, University of Chicago, Chicago, 
Illinois; University of Chicago Hospitals, Chicago, Illinois

True food allergies constitute a different pathogenesis and pathology 
from true IBD. Although the true cause of IBD remains elusive, it 
appears to involve a combination of genetic susceptibility, immune 
dysregulation, and environmental pressures. Patients with IBD are more 
likely to suffer from food allergies or intolerances than the normal 
population, but there is not good evidence to suggest that an allergy is 
the trigger for the underlying inflammatory process. Whereas some groups 
have been able to demonstrate immune responses to certain food antigens 
in patients with Crohn's disease, these findings cannot be replicated in 
other populations, making this mechanism for a pathogenesis unlikely. In 
patients with subclinical disease, an allergy can precipitate IBD 
phenotypes, but again, the link between allergies and causation is weak. 
Certainly those patients who have undiagnosed food intolerances are less 
likely to respond to standard IBD therapies.

Patients should be counseled regarding their dietary habits to monitor 
which specific foods or food groups may trigger worse gastrointestinal 
or systemic symptoms. Elimination diets, however, are rarely needed in 
the IBD patient.
Posted 02/07/2006
Suggested Readings

     * Huber A, Genser D, Spitzauer S, et al. IgE/anti-IgE immune 
complexes in sera from patients with Crohn's disease do not contain 
food-specific IgE. Int Arch Allergy Immunol. 1998;115:67-72.
     * Mantzaris GJ, Roussos A, Koilakou S, et al. Prevalence of celiac 
disease in patients with Crohn's disease. Inflamm Bowel Dis. 2005;11:1029.
     * Van Den Bogaerde J, Cahill J, Emmanuel AV, et al. Gut mucosal 
response to food antigens in Crohn's disease. Aliment Pharmacol Ther. 
2002;16:1903-1915.

Disclosure: Sunanda V. Kane, MD, MSPH, FACG, has disclosed that she has 
received research support or funding from Procter & Gamble, Salix, and 
GlaxoSmithKline. Dr. Kane has also disclosed that she has served as a 
consultant to Aventis, Centocor, Elan, Ferring, Nisshin-Kyorin 
Pharmaceuticals, Procter & Gamble, Shire, TAP Pharmaceuticals, and UCB, 
and has served on the speaker's bureau for Abbott, AstraZeneca, 
Centocor, GlaxoSmithKline, Novartis, Procter & Gamble, Prometheus, 
Salix, Shire, Solvay, and TAP Pharmaceuticals.
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian"  http://www.parkinson.org/
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