Food allergy and eosinophilic esophagitis: Learning what to avoid

Food allergy and eosinophilic esophagitis: Learning what to avoid
-Sandra Hong, MD, Nicola Vogel, MD
doi: 10.3949/ccjm.77a.09018 Cleveland Clinic Journal of Medicine January 2010 vol. 77 1 51-59. (c)2010 The Cleveland Clinic Foundation.

Excerpts:

• The gut flora. When mice are raised in a germ-free environment, they fail to develop normal tolerance.They are also more likely to become sensitized if they are treated with antibiotics or if they lack toll-like receptors that recognize bacterial lipopolysaccharides. Furthermore, human studies suggest that probiotics promote tolerance, especially in preventing atopic dermatitis, although the studies have had conflicting results.
• The gastric pH. Murine and human studies reveal that antacid medications increase the risk of food allergy.
• Three types of immune responses to food. About 20% of all people alter their diet because of concerns about adverse reactions to foods. These adverse reactions include metabolic disorders (eg, lactose intolerance), a reaction to a pharmacologic component such as caffeine or a toxic contaminant of a food (eg, bacterial food poisoning), psychological reactions (eg, food aversion), and documented immunologic responses to a food (eg, food allergy)
  Immunologic reactions to foods can be divided into three categories: mediated by immunoglobulin E (IgE), non-IgE-mediated, and mixed. Therefore, these disorders can present as an acute, potentially life-threatening reaction or as a chronic disease such as eosinophilic gastoenteropathy.