Gastrointestinal Allergy and Eosinophilic Gut Disease

Food allergy may present with obvious reactions such as hives or swelling immediately after eating the problem food (immediate or IgE-mediated food allergy) but this is not always the case. Allergy, particularly in smaller children, may present with a wide variety of different problems often described as delayed or non-igE-mediated food allergy.

Typical symptoms can include:

• •     Colic or abdominal pain
• •     Diarrhoea
• •     Blood in the stools
• •     Gastro-oesophageal reflux (effortless vomiting)
• •     Poor weight gain
• •     Constipation

Until the underlying allergy is identified and removed the symptoms may progress and worsen. Traditional allergy tests may not be helpful here and there is a greater need for a careful, detailed clinical history taken by an experienced physician. Atopy patch testing or provocation challenges may also be required to reach a diagnosis or exclude allergy as the cause of the problems.

Successful identification and removal of the allergen from the diet may lead to significant improvements in symptoms but this is not the whole story. Patients and their parents need to replace essential nutrients that the allergen (e.g. milk) may have provided and need advice on what substitutes are suitable. They also need to know how to recognise and deal with accidental reactions and also be monitored as many food allergies are outgrown. We work closely with specialist allergy dietitians to help successfully manage delayed food allergies.

Over recent years, there has also been a marked increase in the number of patients diagnosed with eosinophilic gastrointestinal disease, such as eosinophilic oesophagitis. These conditions are a type of gut allergy and part of their successful management can be dietary, with carefully managed exclusion diets. These may work on their own or in combination with other medical treatments. We work closely with gastroenterologists as well as specialist allergy dietitians to help manage these challenging conditions.