Table 3.
List of individual symptoms, causative allergens, serum IgE and identified allergy types in each patient of the study group with gastrointestinally mediated allergy (GMA)
| Pat. no. | Main symptoms & allergen(ssensitivity) | Atopy status & serum-IgE | Type of allergy | |
|---|---|---|---|---|
| 1 | Diarrhoea, flush, pruritus | - | 76 | Type I (systemic IgE) |
| Soy flour, egg | ||||
| 2 | Abdominal pain, loose stools | + | 210 | Type I (systemic IgE) |
| Bloating | ||||
| Wheat, nuts | ||||
| 3 | Vomiting, diarrhoea | + | 112 | Type I (systemic IgE) |
| Egg, wheat, soy | ||||
| 4 | Abdominal pain, urticaria | - | 21 | Type I (local IgE) |
| Fish (salmon) | ||||
| 5 | Diarrhoea, abdominal pain | + | 65 | Type I (systemic IgE) |
| Dyspepsia, vomiting | ||||
| Hazelnut, tree pollens | ||||
| 6 | Diarrhoea | - | 89 | Type I (systemic IgE) |
| Wheat, maize, barley | ||||
| 7 | Vomiting, loose stools | + | 112 | Type I (systemic IgE) |
| Right lower quadrant pain | ||||
| Rice, peach | ||||
| 8 | Profuse watery diarrhoea | - | 398 | Type I (systemic IgE) |
| Milk, soy, fish | ||||
| 9 | Diarrhoea, bloating, tachy- | + | 34 | Type III (immune com- |
| Cardia | Plexes present) or | |||
| Pork, beef, soy | Type IV (?) | |||
| 10 | Pruritus, Rhinitis, tachycardia | - | 54 | Type I (systemic IgE) |
| Bloating, diarrhoea | ||||
| Nuts, milk | ||||
| 11 | Colitis, diarrhoea, arthralgia | - | 66 | Type I (systemic IgE) |
| Oral allergy syndrome, rhinitis | ||||
| Celery, carrot, tree & grass pollen | ||||
| 12 | Bloody diarrhoea, hypotension, | - | 6 | Type I (local IgE) |
| And/or abdominal pain, bloating | Type III (IMMUNE | |||
| rice, soy | Complexes) | |||
| 13 | Fever, diarrhoea, hypotension | + | 722 | Type I (systemic IgE) |
| Nuts | ||||
| 14 | Diarrhoea, vomiting, abdominal | - | 6 | Type IV (cellular hyper- |
| Pain | Sensitivity | |||
| cereals (rye, wheat) | ||||
| 15 | Bloating, diarrhoea, eosinophilia | + | 130 | Type I (systemic Ige) |
| Milk, egg | ||||
| 16 | Atopic eczema, diarrhoea, colitis | + | 76 | Type I (local IgE) |
| Abdominal pain | Type IV (cellular hyper- | |||
| Nuts, tree pollen | Sensitivity ?) | |||
| 17 | Rhinitis, vomiting, diarrhoea | + | 111 | Type I (local IgE) |
| Nuts, egg | ||||
| 18 | Diarrhoea, bloating | + | 28 | Type I (local IgE) |
| Wheat, milk | ||||
| 19 | Eosinophilia, bloating, diarrhoea | + | 289 | Type I (systemic IgE) |
| Egg | ||||
| 20 | Gastrointestinal bleeding, colitis | + | 80 | Type I (systemic IgE) |
| Wheat, hazelnut | ||||
| 21 | Chronic diarrhea, bloating, pain | - | 12 | Type IV |
| Pork, beef | ||||
| 22 | Weight loss, diarrhea, pain | - | 43 | Type III (immune |
| soy | Complexes) | |||
| 23 | Loose stools, abdominal pain | + | 78 | Type I (local IgE) |
| Rice, egg | ||||
| 24 | Diarrhea, anaphylaxis | + | 312 | Type I (systemic IgE) |
| Milk, egg | ||||
| 25 | Weight loss, malabsorption | - | 34 | Type I (local IgE) |
| Milk, pork, wheat | ||||
| 26 | Tachycardia, abdominal pain | - | 7 | Type I (local IgE) |
| Pork | ||||
| 27 | Colitis, abdominal pain, pruritus | + | 92 | Type I (local IgE) |
| nuts, apple, tree pollen | ||||
| 28 | Chronic diarrhea | - | 8 | Type IV |
| Rye, | ||||
| 29 | Gastroesophageal reflux | + | 28 | Type I (local IgE) |
| Eosinophilia, intermittent diarrhea | ||||
| milk, beef, tree pollen | ||||
| 30 | Anaphylaxis, urticaria | + | 467 | Type I (systemic IgE) |
| Abdominal colics | ||||
| Egg, milk | ||||
| 31 | Diarrhoea, bloating | + | 28 | Type I (local IgE) |
| Wheat, milk | ||||
| 32 | Microscopic colitis, flush | - | 32 | Type IV |
| Pruritus | ||||
| Maize, rye | ||||
| 33 | Chronic diarrhea, bloating | + | 77 | Type I (local IgE) |
| Abdominal pain, rhinitis | ||||
| Milk, house dust mite, grass pollen | ||||
| 34 | Epigastric and abdominal pain | + | 420 | Type I (systemic Ige) |
| Tachycardia, rhinitis, asthma bronchiale | ||||
| Nuts, wheat, rye, oat | ||||
| 35 | Microscopic enteritis and colitis | - | 22 | Type I (local IgE) |
| Malabsorption, pruritus | ||||
| Egg, wheat, pork | ||||
| 36 | Eosinophilic enteritis, ascites | - | 71 | Type I (local IgE) |
| Abdominal pain, loose stools | ||||
| Maize, rice, fruits | ||||
| 37 | Allergic rhinoconjunctivitis, | + | 412 | Type I (systemic IgE) |
| Epigastric pain, pruritus | ||||
| Pollen, spice, celery | ||||
| 38 | Chronic diarrhea, nausea | + | 123 | Type I (systemic IgE) |
| Soy, pork, rye, pollen | and type III (immune complexes) | |||
| 39 | Eosinophilic esophagitis | + | 24 | Type I (local IgE) and |
| Atopic dermatitis | Type IV | |||
| Egg, milk, pollen | ||||
| 40 | Vomiting, flatulence, | - | 8 | Type IV |
| Hypotonia | ||||
| Wheat, rye, soy bean, milk | ||||
| 41 | Gastric & duodenal ulcer | - | 91 | Type I (local IgE) |
| Gastrointestinal bleeding | ||||
| Eosinophilia | ||||
| Soy flour, nuts, celery | ||||
| 42 | Weight loss, malabsorption | + | 217 | Type I (systemic IgE) |
| Allergic rhinoconjunctivitis | ||||
| Apple, nuts, latex | ||||
| 43 | Intermittent diarrhea | - | 370 | Type I (systemic IgE) |
| Hazelnut | ||||
| 44 | Tachycardia, restlessness | - | 28 | Type I (systemic IgE) |
| Loose stools | ||||
| Wheat, pollen | ||||
| 45 | Oral allergy syndrome, | + | 198 | Type I (systemic IgE) |
| Epigastric pain | ||||
| Nuts, fruits, pollen | ||||
| 46 | Watery diarrhea | - | 36 | Type I (local IgE) |
| Egg, milk | ||||
| 47 | Chronic diarrhea, flatulence | - | 30 | Type IV |
| soy bean, beef, chicken | ||||
| 48 | Urticaria, oral allergy syndrome | + | 42 | Type I (local IgE) |
| Colitis | ||||
| Nuts, pollen | ||||
| 49 | Atopic eczema, proctitis | + | 732 | Type I (systemic IgE) |
| Spice, pollen, hazelnut | ||||
| 50 | Gastrointestinal bleeding | + | 74 | Type I (local IgE) and |
| From enterocolitis | Type IV | |||
| Rye | ||||
| 51 | Dysphagia, epigastric pain | - | 141 | Type I (local IgE) |
| Oral allergy syndrome | ||||
| Fruits, hazelnut, celery | ||||
| 52 | Chronic diarrhea, abdominal | - | 65 | Type I (local IgE) |
| pain and edema | ||||
| pork, maize, moulds | ||||
| 53 | Lymphocytic colitis | + | 122 | Type I (systemic IgE) |
| Pruritus, hypotonia | and type IV | |||
| Banana, fruits | ||||
| 54 | Nausea, vomiting, flatulence | + | 780 | Type I (systemic IgE) |
| Nuts | ||||
| 55 | Oral allergy syndrome, chronic | - | 96 | Type I (local IgE) |
| Diarrhea | ||||
| Wheat, rye | ||||
| 56 | Pruritus, weight loss, | - | 41 | Type IV |
| Malabsorption | ||||
| Wheat, rye, soy flour | ||||
Atopy status was defined as positive, when history or clinical manifestation of the patient gave evidence for seborrheic dermatitis, atopic dermatitis or eczema, asthma bronchiale and/or allergic rhino - conjunctivitis.
For definition of the allergy type, the most dominant immunological signs were chosen to classify the ongoing allergic mechanisms in this population of patients with manifest gastrointestinally mediated allergy. However, some patients displayed symptoms that suggested more than one definitive type of allergy (see for example patient No. 9, 12, 16 etc.): Type I allergy (systemic IgE) was recognised when positive skin and/or antigen specific IgE levels were present in serum, type I allergy (local IgE) was diagnosed when intestinal lavage fluid contained elevated food antigen-specific levels of IgE (>0.35 U/mg protein) [11,23].
Type III allergy was found in 4 patients (no. 9, 12, 22, 38) who showed formation of either IgA, IgM and/or IgE immune complexes during or after allergen application by blinded food challenge, while pre-challenge serum immune complexes were normal during potato-rice diet.
Type IV allergy was diagnosed or suspected in 8 patients who showed markedly increased production of serum TNF levels during or after food challenge, while pre-challenge TNF levels were normal during potato-rice diet. Additionally, in one patient (no. 14) type IV allergy was considered because of a positive antigen-specific lymphocyte proliferation test.