Non-IgE-mediated Allergies
Diagnostic Approaches
Non-IgE-mediated allergies typically manifest with a delayed onset of symptoms, primarily affecting the gastrointestinal tract, although they may also involve the skin or lungs. Depending on which non-IgE-mediated food allergy is present, these symptoms may include nausea, vomiting, diarrhea, abdominal pain and bloody stools, further prompting dehydration, weight-loss, long-term malabsorption, failure to thrive and lethargy.
While IgE-mediated allergies dominate the clinical landscape and are well-understood, non-IgE-mediated allergies pose diagnostic and management challenges due to the variability in symptom manifestation, similarity between different medical conditions and absence of a definitive diagnostic test or biomarker. Some non-IgE-mediated allergies show typical histological changes that can confirm the diagnosis; however, obtaining samples through endoscopy can be challenging, especially in young children who need general anesthesia for the procedure.…
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Diagnostic Approaches
Non-IgE-mediated allergies typically manifest with a delayed onset of symptoms, primarily affecting the gastrointestinal tract, although they may also involve the skin or lungs. Depending on which non-IgE-mediated food allergy is present, these symptoms may include nausea, vomiting, diarrhea, abdominal pain and bloody stools, further prompting dehydration, weight-loss, long-term malabsorption, failure to thrive and lethargy.
While IgE-mediated allergies dominate the clinical landscape and are well-understood, non-IgE-mediated allergies pose diagnostic and management challenges due to the variability in symptom manifestation, similarity between different medical conditions and absence of a definitive diagnostic test or biomarker. Some non-IgE-mediated allergies show typical histological changes that can confirm the diagnosis; however, obtaining samples through endoscopy can be challenging, especially in young children who need general anesthesia for the procedure. The diagnosis of acute Food Protein–Induced Enterocolitis Syndrome (FPIES) often relies solely on clinical history and identification of symptoms consistent with the diagnostic criteria for acute FPIES. On the other hand, chronic FPIES requires additional testing to confirm the diagnosis. The most commonly used techniques for the diagnosis of non-IgE-mediated allergies are elimination diets and oral food challenge (OFC).
References
- Agyemang A, Nowak-Wegrzyn A. Food Protein-Induced Enterocolitis Syndrome: a Comprehensive Review. Clinic Rev Allerg Immunol. 2019;57(2):261-271.
- Calvani M, Anania C, Cuomo B, et al. Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis. Nutrients. 2021;13(1):226.
