Table 1.

Clinical manifestations of gastroenteric allergy.

Disorder	Mechanism	Symptoms	Diagnosis
Gastrointestinal anaphylaxis	IgE	Rapid onset of nausea, abdominal pain, cramps, vomiting and/or diarrhoea; other target organ responses (i.e. skin, respiratory tract) often involved	Clinical history and positive SPT responses or RAST results; ±oral challenge
Allergic eosinophilic oesophagitis	IgE and/or cell-mediated	Gastro-oesophageal reflux or excessive spitting-up or emesis, intermittent dysphagia, abdominal pain, irritability, sleep disturbance, failure to respond to conventional reflux medications	Clinical history, SPTs, endoscopy and biopsy, elimination diet and challenge
Allergic eosinophilic gastroenteritis	IgE and/or cell-mediated	Recurrent abdominal pain, irritability, early satiety, intermittent vomiting, FTT and/or weight loss, peripheral blood eosinophilia (in 50%)	Clinical history, SPTs, endoscopy and biopsy, elimination diet and challenge
Food protein-induced proctocolitis	Cell-mediated	Gross or occult blood in stool; typically thriving; usually presents in first few months of life	Negative SPT responses; elimination of food protein/clearing of most bleeding in 72 h; 6 endoscopy and biopsy; challenge induces bleeding within 72 h
Food protein-induced enterocolitis	Cell-mediated	Protracted vomiting and diarrhoea, (also bloody), not infrequently with dehydration; abdominal distention, FTT; vomiting typically delayed 1–3 h after feeding	Negative SPT responses; elimination of food protein/clearing of symptoms in 24–72 h, challenge/recurrent vomiting within 1–2 h; 15% have hypotension
Food protein-induced enteropathy	Cell-mediated	Diarrhoea or steatorrhoea, abdominal distention and flatulence, weight loss or FTT, nausea and vomiting, oral ulcers	Endoscopy and biopsy; elimination diet with resolution of symptoms and food rechallenge

FTT: failure to thrive; IgE: immunoglobulin E; RAST: radioallergosorbent test; SPT: skin prick test.