title: A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy.
abstract: OBJECTIVE
  Although immunoglobulin (Ig)E-mediated allergies are readily identifiable, non-IgE-mediated allergies present more diagnostic difficulty. We performed a formal retrospective analysis to determine whether there is a recognizable clinical pattern in children.
  
  
  METHODS
  We studied 121 children (mean age, 17.3 months) with multiple food allergies who were recruited on the basis of adequate immunological assessment by using case notes and parental questionnaire.
  
  
  RESULTS
  Group 1 (n=44) had rapid reactions to dietary antigens, of whom 41 also showed delayed reactions. Group 2 (n=77) had delayed reactions only. Mean IgE was increased in group 1 but both groups otherwise shared a pattern of increased IgG1, decreased IgG2/4, and low-normal IgA. Lymphocyte subsets were skewed, with an increased percentage of CD4 and CD19 and decreased CD8 and natural killer cells. Gastroesophageal reflux, esophagitis, subtle enteropathy, and constipation were frequent in both groups. Of 55 exclusively breast-fed infants, 44 sensitized before weaning. Twenty-one of the mothers suffered from autoimmunity.
  
  
  CONCLUSIONS
  There appears to be a recognizable pattern of immune deviation and minor enteropathy in children with multiple food allergy, irrespective of the speed of reactions. Disturbed gut motility is particularly common, as is a maternal history of autoimmunity.
authors.affiliation: Centre for Paediatric Gastroenterology and Department of Dietetics and Histopathology, Royal Free and University College School of Medicine, London, United Kingdom.
authors.forename: Frances
authors.initials: F
authors.lastname: Latcham
authors.forename: Francisca
authors.initials: F
authors.lastname: Merino
authors.forename: Alison
authors.initials: A
authors.lastname: Lang
authors.forename: Josephine
authors.initials: J
authors.lastname: Garvey
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thomson
authors.forename: John A
authors.initials: JA
authors.lastname: Walker-Smith
authors.forename: Susan E
authors.initials: SE
authors.lastname: Davies
authors.forename: Alan D
authors.initials: AD
authors.lastname: Phillips
authors.forename: Simon H
authors.initials: SH
authors.lastname: Murch
mesh_terms: D018941:Antigens, CD19 / Q000097:blood / Q000276:immunology; D001706:Biopsy; D001942:Breast Feeding; D015704:CD4 Antigens / Q000097:blood / Q000276:immunology; D003092:Colitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D003248:Constipation / Q000453:epidemiology; D003876:Dermatitis, Atopic / Q000453:epidemiology / Q000235:genetics; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications* / Q000453:epidemiology / Q000276:immunology*; D005526:Food, Formulated; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007073:Immunoglobulin E / Q000276:immunology*; D007074:Immunoglobulin G / Q000276:immunology*; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D015588:Observer Variation; D011852:Radioallergosorbent Test; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D018941:Antigens, CD19; D015704:CD4 Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007073:Immunoglobulin E