Do pre- and postchallenge small intestinal biopsies help to diagnose cow's milk protein intolerance?

Food protein-induced enterocolitis syndrome: laboratory perspectives

The expression of food protein allergy in man is very heterogeneous, varies with the age of the subject and is to a certain extent genetically determined. Skin prick tests with standardized food extracts are a sensitive method for detection of immunoglobulin E bound to reactive cells such as mast cells. Various tests on cellular immunity have been developed, especially because T-cell mediated reactions are considered to play a role in mainly delayed gastrointestinal reactions to cow's milk proteins. Food allergy may involve the entire gut, from mouth to rectum, including the esophagus. Abnormalities in intestinal permeability are the hallmarks of the inflamed gut, and may contribute to diagnosis of food induced enteropathy. What determines the characteristics of the intestinal inflammatory response is largely the cytokine responses triggered by the pathologic mechanism, whatever its origin, in the stomach, the small intestine, and the colon. A so-called T-helper type 2 response is characteristic of the allergic subject. A secretion of tumor necrosis factor-alpha alpha by blood cells of children allergic to milk was shown. All means of investigation may help in analyzing food substitutes for allergic infants.

Protein intolerance and immunocyte and enterocyte interaction

Food allergy is an untoward immunologic reaction to food. The number of conditions that need to be considered in the differential diagnosis is large and includes adverse reactions to foods that do not have an immunologic basis. Intestinal immune elements are an integral feature of the intestinal mucosa and, besides modulating gastrointestinal function, represent a significant part of the host's overall immune system. Despite increasing knowledge, the precise disturbances in immune function that lead to the appearance of food allergy are still unclear. Food allergy will remain primarily a clinical diagnosis, relying on history and response to dietary elimination and rechallenge until more specific tests become available.

Food allergy and intolerance

This article focuses on intolerance to food proteins, discussing the definition and history of food intolerance, the basics of gastrointestinal mucosal immunity, specific food antigens, pathogenesis, clinical manifestations, as well as diagnosis, therapy, and prevention.

A prospective study of cow's milk protein intolerance in Swedish infants

1 079 of 1 548 newborn infants were followed during their first year. 328 were prospectively contacted once a month. 751 were followed up at child welfare clinics. Altogether 20 were diagnosed as being cow's milk protein intolerant (1.9%). Symptoms from the gastrointestinal tract and the skin predominated. Only 2 had respiratory symptoms. Ten had their symptoms within one week after the introduction of cow's milk, 3 of them at their first cow's milk-containing meal. A further 4 already had symptoms when fed only human milk. The others (6 infants) showed symptoms after more than one week on a cow's milk containing diet. Before 2 years of age, 13 had recovered. Twelve of the cow's milk protein intolerant infants also showed adverse reactions to other foods, soy-protein intolerance being the most common (7 infants). A family history of allergy was found in 35% (116) of the 328 infants and in 70% (14) of those with cow's milk protein intolerance.