Abstract
BackgroundIrritable Bowel Syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology.ObjectiveWe sought to investigate whether specific type 4 food allergens identified by skin patch testing, when eliminated from the diet, alleviate symptoms of IBS.MethodsIn this case series, skin patch testing was performed on 60 IBS patients using an extensive panel of type 4 food allergens after which food avoidance diets directed by the patch test results were implemented. Questionnaires assessing abdominal pain/discomfort and global improvement in IBS symptoms were used to assess one month and three or more month outcomes. ResultsThere were statistically significant improvements in abdominal pain/discomfort and in global IBS symptoms after one month and again at an average of 7.6 months of patch test-guided food avoidance.ConclusionsSustained improvement with avoidance of type 4 food allergens identified by skin patch testing suggests a role for delayed-type food hypersensitivities in the pathogenesis of some cases of IBS. A subset of patients whose IBS symptoms resolve completely may be better characterized as having a newly proposed disease, allergic contact enteritis (ACE).
Highlights
Sustained improvement with avoidance of type 4 food allergens identified by skin patch testing suggests a role for delayed-type food hypersensitivities in the pathogenesis of some cases of Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is the most common gastrointestinal (GI) disorder presenting to a primary care office, accounting for up to 50% of visits associated with a GI problem[1]
Patients who were pregnant; were known to have an allergy to adhesive tape or any of the food allergens used in the study; had a severe skin rash; had symptoms that had a known cause other than IBS; or were on active treatment with any systemic immunosuppressive medications were excluded from the study
Summary
Irritable Bowel Syndrome (IBS) is the most common gastrointestinal (GI) disorder presenting to a primary care office, accounting for up to 50% of visits associated with a GI problem[1]. The preponderance of investigation of food allergy in IBS has focused on the antibody-mediated humoral (type 1, 2 and 3 allergy) arm of the immune system Both a landmark consensus report considering all aspects of food allergy[12] issued by the National Institutes of Allergy and Infectious Disease and a comprehensive position statement on IBS management[13] by an American College of Gastroenterology task force fail to invoke an immunologic mechanism for the pathogenesis of IBS, by default suggesting a poorly understood non-immunologic mechanism for food intolerance. Irritable Bowel Syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology
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