A consistent pattern of minor immunodeficiency and subtle enteropathy in children with multiple food allergy.
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.
Latcham
Frances
F
Centre for Paediatric Gastroenterology and Department of Dietetics and Histopathology, Royal Free and University College School of Medicine, London, United Kingdom.
Merino
Francisca
F
Lang
Alison
A
Garvey
Josephine
J
Thomson
Michael A
MA
Walker-Smith
John A
JA
Davies
Susan E
SE
Phillips
Alan D
AD
Murch
Simon H
SH
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
D018941:Antigens, CD19; D015704:CD4 Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007073:Immunoglobulin E