Adverse Food Reactions Research Articles

Sensitization and allergy to pineapple and coconut juice in patients followed up for allergic diseases in Parakou, Benin

Objectives: Little is known about adverse food reactions. The aim of this study was to investigate the sensitization and allergy to two tropical fruits, pineapple (Ananas comosus) and coconut (Cocos nucifera), among patients followed up for allergic disease in Borgou Teaching Hospital in Parakou, Benin. Materials and Methods: A prospective cross-sectional study was conducted in 2021. Adult patients (≥18 years) who were followed up for allergic asthma, rhinitis, or conjunctivitis were included in the study. Information on clinical manifestations following pineapple juice or coconut water drinking was collected, and skin prick testing was carried out. Results: Overall, 101 patients were enrolled, male-female ratio of 0.4:1 and mean age of 33.4 (±14.4) years. Clinical manifestations were triggered by pineapple in 53.5%, mainly mouth and lip pruritus (38.6%). The prevalence of sensitization was 36.6%. Allergy was diagnosed in 24.8% (or 46.3% of those who complained) and was associated with mouth and lip pruritus (odds ratio [OR] = 4.1; 95% confidence interval [CI] = 1.6–10.6; P = 0.003), bronchospasm (OR = 3.7;95%CI = 1.1–12.7; P = 0.031), allergic rhinitis (OR = 3.5; 95%CI = 1.2–10.4; P = 0.020), and conjunctivitis (OR = 4.4; 95%CI = 1.6–12.5; P = 0.007). Clinical manifestations after ingestion of coconut water reportedly occurred in 18.8% and were mostly bronchospasm (8.9%). The prevalence of sensitization was 20.8%. Allergies were diagnosed in 6.9% (or 33.3% of those who complained), with no association found with demographic or clinical characteristics. Conclusion: Pineapple is a common cause of food allergy among patients who are followed up in Borgou Teaching Hospital, while coconut is less responsible for this disorder. More studies are required to improve knowledge of allergic diseases in Sub-Saharan Africa, which is facing an epidemiological transition.

Dietary options for diagnosis of cutaneous adverse food reactions

Diet is critical for the diagnosis of cutaneous adverse food reactions in dogs and cats. The diagnostic process consists of the elimination trial, where a diet the patient has never been exposed to or with reduced allergenicity (elimination diet) is fed for a number of weeks exclusively. If clinical signs improve, this is followed by a challenge phase to confirm the diagnosis and identify the food triggers in each patient. Therefore, choosing the right elimination diet is very important in obtaining a reliable diagnosis and deciding on the best feeding plan for long-term management. This paper reviews the different options for canine and feline elimination diets and discusses their pros and cons.

Польза элиминационной диеты из гидролизованной рыбы и рисового крахмала для диагностики неблагоприятных пищевых реакций у кошек: открытое клиническое исследование

Background: diagnosis of adverse food reaction (AFR) is based on an eight week elimination diet (ED) and is confirmed by relapse upon re-challenge with the previously fed diet. Hydrolysed EDs are commonly used for this purpose. Objective: to evaluate the commercially available hydrolysed fish protein and rice starch ED Farmina UltraHypo (FUH) for the diagnosis of feline AFR. Animals: thirty-two nonseasonally pruritic cats. Materials and methods: pruritus was assessed with a new dual Visual Analog Scale, lesions with the Scoring Feline Allergic Dermatitis scale and Quality of Life with a validated questionnaire on days 0 and 56. Short-acting corticosteroids or oclacitinib were permitted during the first six weeks. Cats showing 50% pruritus and/or lesional improvement were separately challenged with their prior diet, fish and rice. Cats not responding to the study diet were fed another hydrolysed diet for two months. Results: 25 cats completed the ED: four dropped out due to vomiting and/or diarrhoea, one owing to low palatability and two were lost to follow-up. In 17 cats, pruritus improved by >50% and these underwent dietary challenges. Of these, nine reacted to their prior diet and/or fish and/or rice and were diagnosed with AFR, while eight did not relapse (and a diagnosis of AFR was considered to be doubtful). Of the eight cats in which pruritus did not improve, four underwent a second ED with no improvement. Conclusion and clinical importance: FUH may be a useful ED for the diagnosis of feline AFR, even in cats reacting to fish or rice

Adverse Food Reactions: Physiological and Ecological Perspectives.

While food is essential for survival, it can also cause a variety of harmful effects, ranging from intolerance to specific nutrients to celiac disease and food allergies. In addition to nutrients, foods contain myriads of substances that can have either beneficial or detrimental effects on the animals consuming them. Consequently, all animals evolved defense mechanisms that protect them from harmful food components. These "antitoxin" defenses have some parallels with antimicrobial defenses and operate at a cost to the animal's fitness. These costs outweigh benefits when defense responses are exaggerated or mistargeted, resulting in adverse reactions to foods. Additionally, pathological effects of foods can stem from insufficient defenses, due to unabated toxicity of harmful food components. We discuss the structure of antitoxin defenses and how their failures can lead to a variety of adverse food reactions.

Exploring genetic variants in congenital monosaccharide-disaccharide metabolism: Carrier ratiosandphenotypic insights.

Adverse food reactions, often underestimated, encompass congenital monosaccharide-disaccharide metabolism disorders, yielding diverse outcomes such as abdominal pain, diarrhea, bleeding disorders, and even death. This study retrospectively scrutinized genetic variants linked to these disorders in a cohort subjected to whole-exome sequence analysis (WES), determining carrier frequencies and genotype-phenotype correlations. Data from 484 patients, were retrospectively analyzed using a gene panel (ALDOB, FBP1, GALE, GALK1, GALM, GALT, LCT, SLC2A2, SLC5A1, SI) for congenital monosaccharide-disaccharide metabolism disorders. WES was performed on patients using the xGen Exome Research Panel v2 kit, utilizing Next Generation Sequence Analysis (NGS). The study encompassed pathogenic, likely pathogenic, and variant of uncertain significance (VUS) variants. Among 484 patients (244 female, 240 male), 17.35% carried 99 variants (67 distinct) in the analyzed genes. Pathogenic/likely pathogenic allele frequency stood at 0.013, while VUS allele frequency was 0.088. Notably, 44% (37/84) of patients harboring mutations manifested at least one relevant phenotype. Carriage frequencies ranged from 1:25 (SI gene) to 1:968 (GALE gene), with the estimated disease frequency spanning from 1:2500 to 1:3748000. Our study underscores clinical manifestations in heterozygous carriers of recessive genetic disorders, addressing gaps in carrier frequencies and phenotypic effects for congenital monosaccharide-disaccharide metabolism disorders. This knowledge can improve these conditions'diagnosis and management, potentially preventing adverse food reactions and their associated complications.

Ctrl-X, Ctrl-C and Ctrl-V in Veterinary Dermatology: Skin microbiota transplantation as a promising approach for dogs with cutaneous adverse food reactions

The probability of influencing the skin microbiome for addressing skin disorders opens a novel aisle of therapy. This study aimed to evaluate the efficacy of skin microbiota transplantation (sMt) for cutaneous adverse food reactions (caFr) in dogs. Ten client-owned dogs with caFr were included in the study. Unenriched heterologous sMt was performed using Nivea Skin Refining Clear-Up Strips (N-cUs). The bacterial microbiota of skin samples was analysed by next-generation sequencing of the 16S rRNA gene. Other relevant biomarkers were involved in VAS (visual analogue scale of pruritus score), CADESI-04 (canine atopic dermatitis extent and severity index) and epidermal corneometric analysis. Increased Faecalibacterium (0 to 1.9 %), Peptoclostridium (5.49 % to 9.11 %) and Collinsella (0.65 % to 8.91 %), and decreased Fusobacterium (19.16 % to 9.06 %), Porphyromona (8.75 % to 0.13 %), Streptococcus (1.63 % to 0.14 %) and Staphylococcus (1.09 % to 0.49 %) was evidenced before and after sMt, respectively. Treatment with sMt effectively controlled clinical signs and drastically reduced median VAS pruritus (6.5 vs. 2) and CADESI-04 scores (74.50±22.62 to 19.30±11.30) (p<0,001). In addition, skin pH and hydration values were improved (p<0,001) after sMt. The heterologous and unenriched sMt with N-cUs could be responsible for the clinical recovery observed in this study.

Evaluation on Food Allergy in Young Females in the Age Group of 18-25 Years. A Study from Tamilnadu, India.

The development of allergies to foods, one of the most common forms of immune-mediated adverse food reactions, is characterized by the presence of IgE. Inflammation that is triggered by cell components and brought on by T lymphocytes and eosinophils may accompany it. Food allergy study was carried out at Sree Ramakrishna medical college of naturopathy and yogic sciences and hospital in Kulasekharam, Tamil Nadu, India. Females between the ages of 18 to 25 are participating in the study. After the purpose of the study was described, verbal consent was obtained. 30 people answered this questionnaire. The survey consists of thirty questions. The questionnaire parameters covered the following topics anxiety, skin diseases, facial hygiene, and digestive issues. Female participants who were unwilling or uncooperative were not allowed to continue with the study. Food allergies affect most women. They do not eat a healthy, balanced diet. The level of knowledge regarding the amount of food and water consumed is not typical. Thus, there is a greater need to educate women about the need to maintain excellent hygiene, eating a balanced diet, and drinking enough water. Future health care initiatives should focus on these areas to enhance the general health and well-being of young women.

AKTUALNE PERSPEKTYWY ZASTOSOWANIA PROTEOMIKI DO IDENTYFIKACJI ORAZ CHARAKTERYSTYKI BIAŁEK POCHODZENIA OWADZIEGO WYKAZUJĄCYCH POTENCJAŁ ALERGIZUJĄCY

Currently, pet owners can easily access a broad array of commercial pet products specifically formulated to meet the unique nutritional needs of their cats and dogs. The trend towards organic pet foods, prioritizing whole ingredients over processed ones, is gaining more and more attention, emphasizing sustainability in sourcing dietary proteins. Insects, rich in essential amino acids, emerge as promising protein substitutes, though they do carry potential risks of triggering adverse food reactions, such as allergies in pets. This, in turn, provides a fertile ground for advanced proteomic analysis, facilitating comprehensive identification and quantification of allergens from edible insects. This includes defining immune epitopes originating from these allergens, thus fostering the discovery of potentially new proteins with allergenic potential and aiding in the in vitro diagnosis of allergen sensitization. This review presents the latest advancements in edible insect-derived allergens and the proteomic investigations conducted to analyse them. We offer insights into classical and advanced proteomic approaches designed for identifying and quantifying these allergens in various food matrices. Additionally, we focus on recent studies concerning the characterization of novel insect allergens, exploring sensitization and cross-reactivity mechanisms, with a specific emphasis on pets.

Establishment of clinical criteria for the diagnosis of adverse food reactions in dogs with atopic dermatitis.

Diagnosis of canine adverse food reactions (AFRs) is based on vague criteria, such as '>50% improvement' during elimination diet trial (EDT) followed by 'deterioration' during provocation test (PT). The objective of the study was to use predefined criteria to evaluate response during EDT [i.e., Owner Global Assessment of Treatment Efficacy (OGATE) = good-to-excellent] and relapse during PT [i.e., Owner Global Assessment of Challenge Deterioration (OGACD) = moderate-to-severe and/or >100% increase of lesional (Canine Atopic Dermatitis Extent and Severity Index, 4th iteration, CADESI-04) and/or of pruritus (pruritus Visual Analog Scale, PVAS) scores]. Twenty-nine dogs with atopic dermatitis. An extensively hydrolysed diet was fed to all dogs followed, in seven of 11 nonresponders, by a second home-made novel-protein EDT. Dogs responding to either EDT were challenged with their previous diet. Thirteen (44.8%) dogs were diagnosed with AFRs: at the end of EDT, their OGATE was good (9 of 13; 69.2%) or excellent (four of 13; 30.8%), and both CADESI-04 (46.7%) and PVAS (71.1%) had decreased significantly; at the end of PT, OGACD was moderate or severe in 12 of 13 (92.3%) dogs, and both CADESI-04 (127.9%) and PVAS (181.8%) had increased significantly. Of the 16 dogs without AFRs, 6 (37.5%) responded to the commercial (n = 5) or home-made (n = 1) diet [OGATE = good (three of six) or excellent (three of six)], with significant concurrent reduction of CADESI-04 and nonsignificant reduction of PVAS, yet they did not relapse during PT. The proposed (predefined) criteria for the evaluation of response during EDT and deterioration during PT seem reliable and are easily applicable in clinical practice and research.

A reliable enzyme-linked immunosorbent assay for the determining of sesame proteins in raw food ingredients and in processed foods

Sesame is a frequent cause of adverse food reactions in allergic patients. We developed a novel sandwich enzyme-linked immunosorbent assay (ELISA) using two monoclonal antibodies and a unique extraction buffer for the detection and quantification of sesame proteins in processed foods and in raw food ingredients to clarify the validity of sesame labeling and for precautionary allergen labeling. The developed sandwich ELISA method is highly specific for sesame proteins. The limit of detection (LOD) and limit of quantification (LOQ) are 0.013 µg/g and 0.025 µg/g, respectively. The recoveries for incurred food samples, such as dressing, breads, sauce and pudding, ranged from 67 % to 81 %, while the repeatability and reproducibility coefficients of variation were less than 4.7 % and 4.5 %, respectively. The developed method has applicability for food products and is a reliable tool for the detection of hidden sesame proteins in raw food ingredients and in processed foods.

A5 DEVELOPMENT OF A PRE-CLINICAL MOUSE MODEL TO INVESTIGATE ADVERSE FOOD REACTIONS IN INTESTINAL INFLAMMATION

Abstract Background Patients with chronic intestinal conditions, including inflammatory bowel disease (IBD), experience diverse food-related adverse reactions. However,, the precise mechanisms of food intolerances in IBD remains unclear. Emerging evidence suggests that altered diet-microbiota interactions can contribute to the development of IBD. Previously we shown that intestinal microbiota plays an important role in the development of food intolerances. We hypothesize that microbial alterations in IBD patients facilitate adverse reactions to foods. Aims To establish a preclinical mouse model to study adverse food reactions in intestinal inflammation. Methods Eight-week-old C57BL/6 mice were treated with 3% dextran sodium sulfate (DSS) for 5 days, then divided into three groups. The first group was sensitized to dairy protein (3% casein and 3% whey), using 4 oral administrations of cholera toxin over 2 weeks, without any further diet intervention. The second group was also sensitized to casein and whey, then after 1 week of recovery, the mice were subsequently place on a chow containing casein and whey. Finally, the third group was subjected to diet intervention without sensitization. The same experiment was repeated in a different subset of C57BL/6 mice which included a second cycle of DSS (1.5%) during the dietary interventions. Markers of intestinal inflammation (disease activity index (DAI), histological damage, cell infiltration and pro-inflammatory genes expression (NanoString)) and intestinal microbiota were analysed after 1 week of the diet intervention. Results Mice previously sensitized on the dairy diet exhibited an enhanced activation of immune cells after intestinal inflammation. While the histological damage score did not reveal significant differences among experimental groups, the sensitized group under dairy intervention exhibited an elevated level of immune cell infiltration, increasing the polymorphonuclear, CD3+ and mast cells. Gene expression also revealed that dairy induced the expression of inflammatory genes, such as C6, Arg1, Tnf, Il6, Cxcl9 and Cxcl10. When animals are subjected to a second DSS-cycle, dairy worsen colitis in mice previously sensitized, as shown by higher DAI compared to group with control diet and dairy diet without sensitization. Conclusions In the context of intestinal inflammation, dairy protein leads to immune activation characterized by an increase in polymorphonuclear cells, mast cells and lymphocytes, as well as worsening colitis. Future studies using this model will provide valuable insights into the role of intestinal microbiota in food intolerances associated with intestinal inflammation. Funding Agencies CCC

Outcomes of double-blind, placebo-controlled food challenges with seawater and freshwater shrimps in Chinese patients with adverse food reactions to shrimp

Outcomes of double-blind, placebo-controlled food challenges with seawater and freshwater shrimps in Chinese patients with adverse food reactions to shrimp

Adverse Food Reactions in Inflammatory Bowel Disease: State of the Art and Future Perspectives.

Limited knowledge is available about the relationship between food allergies or intolerances and inflammatory bowel disease (IBD). Clinicians frequently encounter patients who report food allergies or intolerances, and gastroenterologists struggle distinguishing between patients with organic disorders and those with functional disorders, which the patients themselves may associate with specific dietary components. This task becomes even more arduous when managing patients with significant underlying organic conditions, like IBD. The aim of this review is to summarize and emphasize any actual associations between food allergies and intolerances and inflammatory diseases, such as ulcerative colitis and Crohn's disease. Through a narrative disceptation of the current literature, we highlight the increased prevalence of various food intolerances, including lactose, fructose, histamine, nickel, and non-celiac gluten sensitivity, in individuals with IBD. Additionally, we explore the association between increased epithelial barrier permeability in IBD and the development of food sensitization. By doing so, we aim to enhance clinicians' awareness of the nutritional management of patients with IBD when facing complaints or evidence of food allergies or intolerances.

Exploring the links between necrotizing enterocolitis and cow's milk protein allergy in preterm infants: a narrative review.

A broad range of allergic disorders and intolerance are associated with cow's milk protein in the infant diet. Allergy and intolerance to cow's milk proteins are commonly recognized in the healthy term infant, and the prevalence cow's milk protein intolerance (CMPI) varies widely but 5 challenge confirmed studies free from selection bias ranged from 1.9%-4.9%. These disorders are classified by the presence of IgE, non-IgE or T-cell-mediated signaling. Additionally, the severity of these adverse food reactions can range from mild gastrointestinal symptoms to severe sepsis-like episodes, as in the case of food protein-induced enterocolitis syndrome (FPIES). Food protein-induced intolerance in the healthy young infant lies in stark contrast to enterocolitis that typically occurs in the preterm neonate. Necrotizing enterocolitis (NEC) is a distinct progressive disease process, usually characterized by a high mortality rate, with a risk of death from 30% to 50%. While its exact etiology is unclear, its main triggers include formula (cow's milk protein), hypoxia, perfusion-related issues, and unregulated inflammation in the premature intestine. The distinction between NEC and cow's milk protein intolerance is difficult to discern in some cases. In the late preterm population, infants with colitis can have both NEC and cow's milk intolerance on the differential. In infants with multiple episodes of mild NEC, cow's milk protein intolerance may be the underlying diagnosis. In this review, we compare the pathophysiological characteristics, diagnosis and treatment of disorders of cow's milk protein intolerance with the entity of preterm NEC. This review highlights similarities in both entities and may inspire future cross-disciplinary research.

Immunoglobulin E–Mediated Food Allergies: Why Differentiate From Other Adverse Food Reactions?

Immunoglobulin E–Mediated Food Allergies: Why Differentiate From Other Adverse Food Reactions?

B-102 Screening Food Allergies in Our Health Primary Care Area

Abstract Background Allergy is the immunological disease with the greatest impact in the world. Food allergy typically manifests with cutaneous, digestive and/or respiratory symptoms, of immediate onset, usually immunoglobulin E-mediated. Doctors from primary health-care providers are often challenged with these patients, becoming the first-line for the recognition and management of food allergies. As a laboratory, our duty is to provide the health care system with the most effective diagnostic tools. Methods We recollected all the results from Primary care of our health area analyzed in our laboratory for one year. Screening assay included a panel of specific IgE antibodies to the most common food allergens: egg yolk, egg white, milk, cod, wheat, peanut and soybean. They were detected semi-quantitatively by enzyme-labeled chemiluminescent immunoassay using the Immulite Allergy Food Panel FP5 kit (Siemens Diagnostic Products Corporation, Los Angeles, USA), according to the test procedure. If the assay was positive, all specific IgE allergens contained in the mixture were analyzed separately to determine their responsibility for the positive screening test. Results Our laboratory processed 24 125 samples from primary care patients. Of these, 1251 were positive (greater than 0.35 Ku/L), which represented 5.19% positive of the total analyzed. Once all the specific IgE allergens contained in the mixture were analyzed, the results were: 608 positive for egg yolk, 753 positive for egg white, 523 positive for milk, 109 positive for cod, 405 positive for wheat, 597 positive for peanut and 480 positive for soybean. Conclusion As with most medical disorders, a thorough medical history is the initial step in diagnosing adverse food reactions. The medical history is extremely useful, especially in acute reactions, but it can be unreliable in chronic disorders such as atopic dermatitis and asthma. In vitro assays help in the diagnosis, but they must be considered as a screening and no diagnosis tool, especially when no symptoms are associated with the positive food allergen result. That’s why in vitro results must be confirmed by prick test, which is considered gold standard for allergy diagnosis. In our study, egg white is the most prevalent allergen detected (60.19%), followed in order by egg yolk (48.60%), peanut (47.72%), milk (41.81%), soybean (38.37%), wheat (32.37%) and being cod the least allergen detected (8.71%).

An open-label clinical trial to evaluate the efficacy of an elemental diet for the diagnosis of adverse food reactions in dogs.

The diagnosis of cutaneous adverse food reactions (CAFR) in dogs is dependent on a diet trial and provocative challenge. To evaluate the efficacy of an elemental diet for the diagnosis of CAFR in dogs. Sixty-two client-owned nonseasonally pruritic dogs. A prospective, uncontrolled, observational elimination diet trial study. Dogs were fed a commercially available elemental canine diet (Pro Plan Veterinary Diets EL Elemental Canine Formula, Nestlé Purina PetCare Company) for up to eight weeks. Pruritus was assessed using a validated Visual Analog Scale (PVAS), lesions with the Canine Atopic Dermatitis and Severity Index, 4th iteration (CADESI-04) and gastrointestinal (GI) signs with a client questionnaire. All dogs were challenged with their previous diet for up to 14 days. Treats were added from Day (D)7 to D14. Forty-five dogs completed the study. Eighteen (40%) of these were diagnosed with CAFR and 27 (60%) were diet-nonresponsive (NR). Dogs with CAFR flared on provocative challenges within 14 days. The smallest volume of previous diet that induced a CAFR flare was one teaspoon in two dogs (11.1%). The mean number of days leading to a provocation of clinical signs was 4.88 days. Gastrointestinal signs improved in both groups. Eight of the dogs with CAFR (44.4%) were subsequently maintained on the elemental diet alone. Pro Plan Veterinary Diets EL Elemental Canine Formula is efficacious for the diagnosis of canine CAFR. One teaspoon of the offending diet may induce clinical signs in some dogs with CAFR.

Plant Food Dyes with Antioxidant Properties and Allergies-Friend or Enemy?

Color is an important food attribute which increases its attractiveness, thus influencing consumer preferences and acceptance of food products. The characteristic color of fresh, raw food is due to natural dyes present in natural food sources. Food loses its natural color during processing or storage. Loss of natural color (e.g., graying) often reduces the appeal of a product to consumers. To increase the aesthetic value of food, natural or synthetic dyes are added to it. Interestingly, the use of food coloring to enhance food attractiveness and appetizing appearance has been practiced since antiquity. Food coloring can also cause certain health effects, both negative and positive. Dyes added to food, both natural and synthetic, are primarily chemical substances that may not be neutral to the body. Some of these substances have strong antioxidant properties. Thanks to this activity, they can also perform important pro-health functions, including antiallergic ones. On the other hand, as foreign substances, they can also cause various adverse food reactions, including allergic reactions of varying severity and anaphylactic shock. This article discusses food dyes of plant origins with antioxidant properties (anthocyanins, betanins, chlorophylls, carotenoids, and curcumin) and their relationship with allergy, both as sensitizing agents and immunomodulatory agents with potential antiallergic properties.

A case of mucous membrane pemphigoid masquerading as an adverse food reaction in the allergy clinic

Adverse food reactions are a common reason for allergist consultation. Many patients assume their symptoms to be allergic in nature, but severe conditions like mucous membrane pemphigoid (MMP) can be missed if not considered. We report the case of a patient presenting with concern for food allergy found to have MMP.

New Insights and Evidence on "Food Intolerances": Non-Celiac Gluten Sensitivity and Nickel Allergic Contact Mucositis.

The clinical examination of patients often includes the observation of the existence of a close relationship between the ingestion of certain foods and the appearance of various symptoms. Until now, the occurrence of these events has been loosely defined as food intolerance. Instead, these conditions should be more properly defined as adverse food reactions (AFRs), which can consist of the presentation of a wide variety of symptoms which are commonly identified as irritable bowel syndrome (IBS). In addition, systemic manifestations such as neurological, dermatological, joint, and respiratory disorders may also occur in affected patients. Although the etiology and pathogenesis of some of them are already known, others, such as non-celiac gluten sensitivity and adverse reactions to nickel-containing foods, are not yet fully defined. The study aimed to evaluate the relationship between the ingestion of some foods and the appearance of some symptoms and clinical improvements and detectable immunohistochemical alterations after a specific exclusion diet. One hundred and six consecutive patients suffering from meteorism, dyspepsia, and nausea following the ingestion of foods containing gluten or nickel were subjected to the GSRS questionnaire which was modified according to the "Salerno experts' criteria". All patients underwent detection of IgA antibodies to tissue transglutaminase, oral mucosal patch tests with gluten and nickel (OMPT), and EGDS, including biopsies. Our data show that GSRS and OMPT, the use of APERIO CS2 software, and the endothelial marker CD34 could be suggested as useful tools in the diagnostic procedure of these new pathologies. Larger, multi-center clinical trials could be helpful in defining these emerging clinical problems.