Annales 76.3 Allergic or Pseudo-Allergic Gastrointestinal Disorders

Editor(s): Frank Ruemmele. 76.3

The latest Annales Nestlé discusses epidemiology, clinical presentation, diagnosis, pathophysiology and treatment of inflammatory GI disorders, such as eosinophil GI diseases or allergic disorders including food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctitis (FPIAP), as well as complex functional disorders, such as non-celiac gluten sensitivity (NCGS). The differentiation between lactose intolerance and cow’s milk allergy is also approached in this issue, which will help limit misunderstandings in diagnosing and managing these conditions.

Food avoidance or specific restriction diets to relief symptoms is currently very common action among patients, even without any diagnostic analyses, requiring attention from health care professionals. In the present series of 4 articles, this issue is addressed, raising the question of a link between food components and adverse reactions as true allergic reactions or mechanisms of food-induced intestinal complaints other than allergy, calling them “pseudo- allergic gastrointestinal disorders.


Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

The terms food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctitis (FPIAP) describe a well-defined but less well-known form of cow’s milk allergy in infants and children. FPIES and FPIAP are non-IgE-mediated, cellular allergic reactions to foods that account for around 40% of the cases of cow’s milk allergy in infants and young children. In his update, Professor Dupont describes clinical presentations/features, pathophysiology, diagnosis and management of FPIES and FPIAP.

Eosinophilic Gastrointestinal Diseases in Childhood

A different and probably pseudo-allergic, but inflammatory, GI disorder also caused by cow’s milk is in the form of an eosinophilic GI disorder (EGID). EGID can occur in patients with well-known allergy as well as in patients without any notion of atopy or allergy. The present review of Doctor Koutry and Professor Papadopoulou highlights that the clinical presentation depends on the involved GI sites as well as on the extent and the depth of eosinophilic inflammation of the intestinal mucosa, sub-mucosa, or muscularis.

Lactose Intolerance: Common Misunderstandings

Lactose intolerance is a syndrome that consists of the manifestation of one or more symptoms upon consumption of lactose containing foods. Although it is one of the most common forms of food intolerance, lactose intolerance is often confused with cow’s milk allergy (CMA) and is wrongly labelled as “milk allergy.” This is often due to the overlapping symptoms such as abdominal pain, bloating, flatulence, and diarrhea. This review highlights the fundamental differences between lactose intolerance and CMA and explains how this knowledge guides the diagnosis and management of these conditions.

Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

Gluten ingestion can cause a series of distinct clinical disorders with overlapping symptoms. These disorders are celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS). Celiac disease and wheat allergy are widely recognized among pediatricians. In contrast, NCGS is not as well known. NCGS is a syndrome of intestinal and extra intestinal manifestations that occur in response to the ingestion of gluten. Recent data, however, point towards other components of wheat, such as amylase/trypsin inhibitors, wheat germ agglutinins, or fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) that may also trigger clinical symptoms. In this article, Professor Ruemmele discusses the epidemiology, clinical presentation, diagnosis, pathophysiology and treatment of NCGS.