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

Artikel i vetenskaplig tidskrift
Författare Xiao Ping Lin
Jenny Magnusson
S. Ahlstedt
Anna Dahlman-Höglund
Lars Åke Hanson
O. Magnusson
Ulf Bengtsson
Esbjörn Telemo
Publicerad i J Allergy Clin Immunol
Volym 109
Nummer/häfte 5 Pt 1
Sidor 879-887.
Publiceringsår 2002
Publicerad vid Institutionen för laboratoriemedicin, Avdelningen för klinisk immunologi
Institutionen för invärtesmedicin, Avdelningen för reumatologi och inflammationsforskning
Institutionen för samhällsmedicin, Avdelningen för miljömedicin
Institutionen för invärtesmedicin, Avdelningen för lungmedicin och allergologi
Sidor 879-887.
Språk en
Ämnesord Journal article
Ämneskategorier Invärtesmedicin

Sammanfattning

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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