Allergic reactions in the gut have an estimated prevalence of approximately 1%-2% in adults. Clinical symptoms include abdominal pain, nausea, vomiting, cramping, and diarrhea. Intestinal mast cells and intestinal eosinophils have been shown to be involved in the pathogenesis of food-allergy-related enteropathy. In addition to classical IgE-dependent degranulation, other agonists, such as interleukin (IL)-4, have been demonstrated to activate mast cells.29,30 Because low-grade mucosal inflammation predominates in IBS, undiagnosed food allergies may play a role in the promotion and perpetuation of the low-grade inflammatory process.30,31 Food products have variously been reported as causing, perpetuating, or being used to treat IBS, and many patients with IBS report histories of food intolerance concomitant with IBS symptoms.31,32 A study with 150 IBS patients were ELISA tested and were randomized to receive either a diet excluding all foods to which they had tested positive or a placebo diet. At 12 weeks, the true elimination diet resulted in a 10% greater reduction in symptom score than the placebo diet, and increasing to 26% in the fully compliant patients. Additionally, relaxing the elimination diet led to a 24% greater deterioration in symptoms.33 Given the high prevalence of gluten-enteropathy (approximately 1:200 patients) and the overlap between symptoms of celiac disease and IBS, many gastroenterologists believe that every patient with IBS-like symptoms should be tested for this (e.g., with antitransglutaminase IgA titers).
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