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Are There Other Immune Reactions to Food That Are Not Food Allergy?

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Are there other immune reactions to food that are not food allergy?
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Hi, I'm Dr. Dave Stukus. I'm a Professor of Clinical Pediatrics, a Board-Certified Allergist and Immunologist, and I'm also a member of the Medical and Scientific Council for the Asthma and Allergy Foundation of America.

Are there other immune reactions to food that are not food allergy?

Well, when we use the word immune or immune system, we really are talking about allergy because what we're expecting is ingestion of a food will cause reproducible symptoms. So for the vast majority of people that have concerns about food allergies, this really is part of the immune response.

There are some exceptions to this. One notable one is a condition called eosinophilic esophagitis. Eosinophilic esophagitis is becoming increasingly recognized in prevalence and in how it affects people and has variable presentation. It can occur in early childhood, presents in adolescence or adulthood. It involves gastrointestinal symptoms and it can range from more heartburn type symptoms or abdominal pain to having recurrent vomiting or even people getting food impaction because they get strictures in their esophagus.

Eosinophilic esophagitis is caused by eosinophils, which is a type of inflammatory white blood cell being recruited to the esophagus, which is the tube that goes from our mouth to our stomach. Well, eosinophils don't really belong there. When they end up there, they wreak a lot of havoc and they can cause inflammation and irritation, which produces all these symptoms and things like that.

The vast majority of people with eosinophilic esophagitis have other allergic conditions, such as eczema, asthma, environmental allergies, and they may have food allergies as well. And we've also learned that for many people with eosinophilic esophagitis elimination of specific foods in their diet can help treat their symptoms. Most notably, cow’s milk.

Now, ingestion of these foods don't cause immediate symptoms, like somebody who has a traditional food allergy. But removal of the foods often can alleviate those symptoms of eosinophilic esophagitis. So technically speaking, it is an immune response to that food. It's just not something that you can necessarily identify by eating that food.

So hopefully this clarifies a little bit. As always, if you have any concerns about foods causing symptoms in you, please discuss with your personal doctor or seek evaluation from a board certified allergist immunologist.

Categories
Eosinophilic Disorders, Food Allergy
Answered by

David Stukus, MD, is a Professor of Clinical Pediatrics in the Division of Allergy and Immunology, Director of the Food Allergy Treatment Center, and Associate Director of the Pediatric Allergy and Immunology Fellowship Program at Nationwide Children’s Hospital and The Ohio State University College of Medicine. He is board certified in allergy/immunology and pediatrics.

Dr. Stukus has devoted his career to communicating evidence-based medicine and best clinical practice to colleagues, medical professionals of all backgrounds, patients, and the general public. In addition to providing clinical care for children with all types of allergic conditions, he participates in clinical research, quality improvement, patient advocacy, and medical education.

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Thank you VERY much for this post, Dr. Stukus. My now 17-year-old was diagnosed with EOE in first grade. Eliminating cow's milk - in fact, everything from a cow - has changed his life in wonderful ways! When he was in second grade he suggested that I create a Venn diagram to show his food allergies and EOE overlaps to help others understand. His pediatric GI said, "Can I keep this?" We have allergists and we have GI doctors each with their individual specialties but it's MOM who has to handle wholistically all conditions, on top of keeping the diet healthy! THANK YOU to our caring doctors for getting us there!! And thank you again, Dr. Stukus, for bringing EO to LIGHT. - Lou (Mom)

Marie Louise
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