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Local allergic reaction in food-hypersensitive adults despite a lack of systemic food-specific IgE

Journal article
Authors Xiao Ping Lin
Jenny Magnusson
S. Ahlstedt
Anna Dahlman-Höglund
Lars Åke Hanson
O. Magnusson
Ulf Bengtsson
Esbjörn Telemo
Published in J Allergy Clin Immunol
Volume 109
Issue 5 Pt 1
Pages 879-887.
Publication year 2002
Published at Institute of Laboratory Medicine, Dept of Clinical Immunology
Institute of Internal Medicine, Dept of Rheumatology and Inflammation Research
Institute of Community Medicine, Dept of Primary Health Care
Institute of Internal Medicine, Dept of Respiratory Medicine/Allergology
Pages 879-887.
Language en
Keywords Journal article
Subject categories Internal medicine


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. CONCLUSION: 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.

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