A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy

https://doi.org/10.1016/S0022-3476(03)00193-8Get rights and content

Abstract

Objective Although immunoglobulin (Ig)E-mediated allergies are readily identifiable, non-IgE-mediated allergies present more diagnostic difficulty. We performed a formal retrospective analysis to determine whether there is a recognizable clinical pattern in children.

Methods We studied 121 children (mean age, 17.3 months) with multiple food allergies who were recruited on the basis of adequate immunological assessment by using case notes and parental questionnaire.

Results Group 1 (n = 44) had rapid reactions to dietary antigens, of whom 41 also showed delayed reactions. Group 2 (n = 77) had delayed reactions only. Mean IgE was increased in group 1 but both groups otherwise shared a pattern of increased IgG1, decreased IgG2/4, and low-normal IgA. Lymphocyte subsets were skewed, with an increased percentage of CD4 and CD19 and decreased CD8 and natural killer cells. Gastroesophageal reflux, esophagitis, subtle enteropathy, and constipation were frequent in both groups. Of 55 exclusively breast-fed infants, 44 sensitized before weaning. Twenty-one of the mothers suffered from autoimmunity.

Conclusions There appears to be a recognizable pattern of immune deviation and minor enteropathy in children with multiple food allergy, irrespective of the speed of reactions. Disturbed gut motility is particularly common, as is a maternal history of autoimmunity.

Section snippets

Patients and methods

This was a retrospective analysis of clinical, histologic, and immunologic characteristics of infants and children with multiple food allergy (MFA) referred by consultant pediatricians or general practitioners during 1997 through 1999 to the Paediatric Food Allergy Clinic of the Centre for Paediatric Gastroenterology at the Royal Free Hospital, a British Society of Allergy and Clinical Immunology-recognized tertiary referral center. The inclusion criteria used were a secure diagnosis of MFA by

Initial presentation

Of the 121 children studied, symptoms had begun in the first year of life in 43 of 44 children from group 1 and 69 of 77 children from group 2, commencing after gastroenteritis in 1 patient from group 1 and 9 patients from Group 2. Twenty-two of these children were reported by parents to show their first symptoms (irritability, vomiting) in the first week of life, and 42 of the infants within one month. Fifty-five mothers (47%) had exclusively breast-fed until weaning, and 41 of their children

Discussion

We initiated this study because we had noticed a substantial recent increase in the numbers of multiply-sensitized children referred to our clinic, which has provided a regional tertiary service in food allergy for over two decades. We had noted apparent overlap in the clinical presentation of children with multiple food allergy in clinical areas not classically viewed as allergy related. The relative predominance of non-IgE-mediated symptoms in our patients may reflect referral bias towards a

Acknowledgements

We are grateful to colleagues in our biochemistry and immunology departments for their support of the clinical management of these patients. We would like to thank Drs David Webster and Nigel Klein for helpful discussions.

References (40)

  • W.M. Comans-Bitter et al.

    Immunophenotyping of blood lymphocytes in childhood: reference values for lymphocyte subpopulations

    J Pediatr

    (1997)
  • I. Hannet et al.

    Developmental and maturational changes in human blood lymphocyte subpopulations

    Immunol Today

    (1992)
  • J.A. Walker-Smith et al.

    Gastrointestinal food allergy

  • P. Ewan

    Clinical study of peanut and nut allergy in 62 consecutive patients: new features and associations

    BMJ

    (1996)
  • D.J. Hill et al.

    Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment

    Ann Med

    (1999)
  • R.P. Ford et al.

    Cow's milk hypersensitivity:immediate and delayed onset clinical patterns

    Arch Dis Child

    (1983)
  • B.M. Harrison et al.

    Cow's milk protein intolerance: a possible association with gastroenteritis, lactose intolerance and IgA deficiency

    BMJ

    (1976)
  • S.H. Murch

    The immunologic basis for intestinal food allergy

    Curr Opin Gastroenterol

    (2000)
  • N. Iyngkaran et al.

    Causative effects of cow's milk protein and soy protein on progressive small bowel mucosal damage

    J Gastroenterol Hepatol

    (1989)
  • F. Lifshitz et al.

    The response to dietary treatment of patients with chronic post-infectious diarrhea and lactose intolerance

    J Am Coll Nutr

    (1990)

    • Cited by (0)

    View full text
    Copyright © 2003 Mosby, Inc. All rights reserved.