4 Mucosal allergy: role of mast cells and eosinophil granulocytes in the gut |
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| Institution: | 1. Division of Allergy and Immunology, Department of Pediatrics, The Children''s Hospital of Philadelphia, Philadelphia, Pa;2. Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa;3. Division of Gastroenterology, Hepatology and Nutrition; The Children''s Hospital of Philadelphia, Philadelphia, Pa;4. Department of Pathology and Laboratory Medicine, The Children''s Hospital of Philadelphia, Philadelphia, Pa;1. Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA;2. Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI 48108, USA;3. Department of Anesthesiology, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA;1. APC Microbiome Ireland, University College Cork, Cork, Ireland;2. School of Pharmacy, University College Cork, Cork, Ireland;3. School of Microbiology, University College Cork, Cork, Ireland;4. School of Biochemistry and Cell Biology, University College Cork, Cork, Ireland;1. Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8280, 111 South 11th Street, Philadelphia, PA 19107, USA;2. Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8490, 111 South 11th Street, Philadelphia, PA 19107, USA;1. Department of Physiology, Institute of Biomedicine, University of Turku, 20520 Turku, Finland;2. Medical Imaging Center, Department of Radiology, Tampere University Hospital, 33521 Tampere, Finland;3. Department of Anesthesiology and Intensive Care, Turku University Central Hospital and University of Turku, 20520 Turku, Finland;4. Turku PET Centre, Turku University Central Hospital and University of Turku, 20520 Turku, Finland;5. Department of Clinical Neurophysiology, Turku University Central Hospital and University of Turku, 20520 Turku, Finland;6. Department of Psychiatry, Turku University Central Hospital and University of Turku, 20520 Turku, Finland;7. Department of Physiology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland |
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| Abstract: | Despite the progress made in understanding the mechanisms of allergic disease, the pathophysiology and clinical significance of intestinal allergic reactions is largely unclean The intestinal mucosa is pre-destined for allergic reactions against food proteins and other antigens, and a number of studies indicate that allergic reactions occur in the GI tract. However, only a few epidemiological data are available, and the mechanisms are poorly understood. Intestinal allergic reactions may be different to classical IgEmediated reactions because patients with intestinal allergy often have negative skin tests and low levels of serum IgE. There is increasing evidence that, as with the findings in the skin and lung, mast cells and eosinophils play a central role in mediating intestinal allergic reactions. Furthermore, both types of cell are found to be activated in a number of other GI inflammatory diseases such as inflammatory bowel disease, celiac disease and eosinophilic gastroenteritis. However, the relationship between these pathologies and intestinal allergy is largely unclear. A major clinical problem is the lack of appropriate means for confirming the diagnosis of intestinal allergy. However, new test systems have been developed—such as the measurement of eosinophil mediators in stool samples or endoscopic provocation tests performed locally at the intestinal mucosa, which may improve the possibility of identifying afflicted patients on an objective basis. Since symptoms of intestinal allergic reactions are variable and nonspecific, the diagnosis requires the use of multiple tests and the exclusion of other pathologies such as infectious disease or non-immunological intolerance reactions. The preferred therapeutic option is avoidance of the allergens of relevance; however, this approach can be realized only in some patients, whereas others require additional treatment, for example, with oral cromoglycate or corticosteroids. Although we do not yet know to what extent intestinal allergic reactions may be an aetiological factor in GI diseases, such reactions should be considered in the differential diagnosis of unclear intestinal inflammation and irritable bowel syndrome. |
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