Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in westernized countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody–mediated immune responses, there is an increasing recognition of cell-mediated disorders such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are an heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mastcells and basophils.
Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction such as Celiac disease, Eosinophilic Esophagitis (EoE), Food Protein Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilc disorders (Non-EoE EGID) is poorly defined.
In some diseases like Celiac Disease and possibly EoE T cell seems to play a major role in initiating the immunological reaction against food, however in FPIES and FPIAP the mechanism of sensitization is not clear.
Diagnosis require food challenges and/or endoscopies in most of the patients. Celiac disease have some validated biomarkers but none of the other Non-IgE mediated food allergies have such biomarkers that can be used for monitoring or diagnosis of the diseases.
Treatment of Non-IgE food allergy rely on diet (FPIES, Celiac disease and EoE) and/or use of drugs (i.e steroids, PPI) in EoE and Non-EoE EGID.
Non-gE mediated food allergies are object of intense investigation.
Food Allergy, IgE, non-IgE, pharmacologic , metabolic , enzyme
Associate Professor of Pediatrics University of Pennsylvania, Perelman School of Medicine Medical Director Food Allergy Immunotherapy Program Division of Allergy and Immunology The Children’s Hospital of Philadelphia ABR 1216H 3615 Civic Center Boulevard