Local allergic reaction in food-hypersensitive adults despite a lack of systemic food-specific IgE.
BACKGROUND
Objective tools are lacking for the diagnosis of local gastrointestinal inflammatory reactions in skin prick test (SPT)-negative and serum IgE antibody (s-IgE Ab)-negative patients with suspected food allergy.


OBJECTIVE
The purpose of this investigation was to evaluate the presence of eosinophils, T cells, local IgE-bearing cells, IL-4, and IFN-gamma in small intestinal biopsy specimens from adult SPT-negative/s-IgE Ab-negative patients with food allergy during symptomatic and nonsymptomatic periods.


METHODS
Fourteen patients with food allergy-related gastrointestinal symptoms confirmed by double-blinded, placebo-controlled food challenge (DBPCFC) were investigated. Eleven of the patients were SPT-negative and s-IgE Ab-negative. Sex- and age-matched healthy volunteers were used as controls. Duodenal biopsies were studied with immunostaining through use of a panel of mouse monoclonal antibodies specific for eosinophils, CD3, CD4, CD8, IgE, IL-4, and IFN-gamma.


RESULTS
Significant increases in numbers of MBP+ eosinophils, IgE-bearing cells, and T cells were found in the duodenal mucosa of the patients when they were symptomatic in comparison with when they were asymptomatic and in comparison with healthy controls. Numbers of IL-4+ cells were increased and numbers of IFN-gamma+ cells were reduced in the patients when they were symptomatic in comparison with when they were asymptomatic and in comparison with the controls. There were no differences in total s-IgE levels between any of the groups.


CONCLUSIONS
A significant correlation was found between the appearance of symptoms of food hypersensitivity and the duodenal presence of IgE-bearing cells, activated eosinophils, and T cells in patients with negative SPT results and negative s-IgE Ab to the offending food. We suggest that a localized IgE-mediated response caused the gastrointestinal symptoms seen in these patients.
Lin
Xiao Ping
XP
Department of Clinical Immunology, Sahlgrenska University Hospital, Göteborg, Sweden.
Magnusson
Jenny
J
Ahlstedt
Staffan
S
Dahlman-Höglund
Anna
A
Hanson L
Lars A
LA
Magnusson
Olle
O
Bengtsson
Ulf
U
Telemo
Esbjörn
E
D000328:Adult; D017252:CD3 Complex / Q000378:metabolism; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D004386:Duodenum / Q000378:metabolism / Q000473:pathology; D004804:Eosinophils / Q000473:pathology; D000939:Epitopes; D005260:Female; D005502:Food; D005512:Food Hypersensitivity / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis* / Q000097:blood / Q000276:immunology / Q000378:metabolism; D007371:Interferon-gamma / Q000097:blood / Q000378:metabolism; D015847:Interleukin-4 / Q000097:blood / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology; D007421:Intestine, Small / Q000378:metabolism* / Q000473:pathology*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged
D017252:CD3 Complex; D000939:Epitopes; D015847:Interleukin-4; D007073:Immunoglobulin E; D007371:Interferon-gamma