title: Manifestations of food protein induced gastrointestinal allergies presenting to a single tertiary paediatric gastroenterology unit.
abstract: BACKGROUND
  Food protein induced gastrointestinal allergies are difficult to characterise due to the delayed nature of this allergy and absence of simple diagnostic tests. Diagnosis is based on an allergy focused history which can be challenging and often yields ambiguous results. We therefore set out to describe a group of children with this delayed type allergy, to provide an overview on typical profile, symptoms and management strategies.
  
  
  METHODS
  This retrospective analysis was performed at Great Ormond Street Children's Hospital. Medical notes were included from 2002 - 2009 where a documented medical diagnosis of food protein induced gastrointestinal allergies was confirmed by an elimination diet with resolution of symptoms, followed by reintroduction with reoccurrence of symptoms. Age of onset of symptoms, diagnosis, current elimination diets and food elimination at time of diagnosis and co-morbidities were collected and parents were phoned again at the time of data collection to ascertain current allergy status.
  
  
  RESULTS
  Data from 437 children were analysis. The majority (67.7%) of children had an atopic family history and 41.5% had atopic dermatitis at an early age. The most common diagnosis included, non-IgE mediated gastrointestinal food allergy (n = 189) and allergic enterocolitis (n = 154) with symptoms of: vomiting (57.8%), back-arching and screaming (50%), constipation (44.6%), diarrhoea (81%), abdominal pain (89.9%), abdominal bloating (73.9%) and rectal bleeding (38.5%). The majority of patients were initially managed with a milk, soy, egg and wheat free diet (41.7%). At a median age of 8 years, 24.7% of children still required to eliminate some of the food allergens.
  
  
  CONCLUSIONS
  This large retrospective study on children with food induced gastrointestinal allergies highlights the variety of symptoms and treatment modalities used in these children. However, further prospective studies are required in this area of food allergy.
authors.affiliation: Department of Gastroenterology, Great Ormond Street Children's Hospital, Great Ormond Street, London WC1N 3JH, UK. Rosan.Meyer@gosh.nhs.uk.
authors.forename: Rosan
authors.initials: R
authors.lastname: Meyer
authors.forename: Catharine
authors.initials: C
authors.lastname: Fleming
authors.forename: Gloria
authors.initials: G
authors.lastname: Dominguez-Ortega
authors.forename: Keith
authors.initials: K
authors.lastname: Lindley
authors.forename: Louise
authors.initials: L
authors.lastname: Michaelis
authors.forename: Nikhil
authors.initials: N
authors.lastname: Thapar
authors.forename: Mamoun
authors.initials: M
authors.lastname: Elawad
authors.forename: Vijay
authors.initials: V
authors.lastname: Chakravarti
authors.forename: Adam T
authors.initials: AT
authors.lastname: Fox
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
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