There is a growing awareness of what food allergies are and with this, precautions are taken and treatment plans are developed for each person. But we don’t know as much about enterocolitis induced by dietary proteins.
There are several gastrointestinal disorders caused by an abnormal immune response to proteins. Generally speaking, these can be mediated by IgE – as in classic food allergies – or not mediated by IgE.
IgE stands for immunoglobulin E, an antibody that the immune system creates in response to an allergic reaction and which is often involved in food allergies and often causes typical food allergy symptoms such as hives, swelling or wheezing . In enterocolitis, food-specific IgE antibodies are usually not involved.
Enterocolitis, the “non-food” food allergy
The term enterocolitis refers specifically to inflammation of the small and large intestines. It is a little-known “food allergy” that mainly occurs during infancy or early childhood, although in recent years cases have also increased in adults. Although there is no precise data on its prevalence, “some studies place its incidence at around 0.7 per 1,000 children,” explains Dr. Mar Fernández Nieto, from the Allergology Department at the University Hospital of the Jiménez Díaz Foundation.
A survey in the United States in 2019 determined that enterocolitis can affect 0.2% of people. adult population of the country, although the exact data in our country is unknown.
It usually appears in children, from the neonatal period to the age of four, although more and more cases are being diagnosed in adults. We are faced with an underdiagnosed disease, both in children and adults.
In the case where enterocolitis affects infants and children, the foods most involved are those that were previously introduced into their diet, such as milk, eggs and fish, although they are not the only ones since any food, without exception, can be responsible. . This varies according to geographical location because it depends on the eating habits of each population.
Enterocolitis, confusing symptoms
In most cases, the symptoms, which appear mainly between one and four hours after ingestion of the food allergen, are generally digestive: nausea, vomiting or diarrhea during the first meals of introducing a new food. According to Fernández Nieto, “the symptoms worsen with each contact and children usually present irritability, crying, probably due to abdominal pain, vomiting, diarrhea and generalized weakness.” In adults, symptoms are more focused on abdominal cramps accompanied by vomiting, diarrhea and general malaise.
On the other hand, it does not cause rashes or respiratory problems. This means that symptoms are sometimes confused with other conditions, such as bacterial or viral infections, and in many cases they are misdiagnosed as acute gastroenteritis or food poisoning.
An atypical and complex diagnosis
As we have already seen, one of the particularities of this food pathology linked to immunological disorders is its atypical and complex diagnosis since it is not based on traditional allergy tests since it is not a question of a real food allergy. In other words, there is no specific immunoglobulin E against the allergen in question. Thus, the tests carried out – skin tests, prick tests and/or blood tests – to measure IgE levels do not help because they turn out to be negative.
The fact that the reaction is not caused by IgE antibodies means that the diagnosis comes mainly from the exclusion of other diagnoses, whether allergies or digestive disorders, celiac disease or infectious diseases, among others. The diagnosis is also made difficult by the fact that there is a latency period between ingestion and the appearance of symptoms, longer than in an IgE-mediated allergy. The sum of all these conditions makes diagnosis difficult and delays.
Enterocolitis: how it is treated and how it progresses
There is currently no specific treatment to treat enterocolitis. The only way to avoid it is to avoid consuming and ingesting the trigger food. “In the case of infant milk, it is necessary to replace it with a suitable formula with a high degree of protein hydrolysis,” explains Fernández Nieto. As we have already mentioned, in the pediatric population, symptoms usually disappear around the age of five, which in adults tends to be more permanent and becomes chronic.
As the doctor warns, it is possible that “at the allergist’s office, skin and blood tests will be carried out because some cases can develop into a true food allergy with the discovery of positive specific IgE” and, depending on the results , that’s the case. It is possible that allergists evaluate “the food challenge test in the hospital with informed consent,” explains Fernández Nieto.
