There is increasing awareness of what food allergies are and thanks to this, precautions are taken and treatment plans are developed for each person. But we are not as familiar with food protein-induced enterocolitis.
There are several gastrointestinal disorders caused by an abnormal immune reaction to proteins. Broadly speaking, these can be IgE-mediated—as in classic food allergies—or non-IgE-mediated.
IgE stands for immunoglobulin E, an antibody that the immune system creates in response to an allergic reaction and is often involved in food allergies and often causes typical food allergy symptoms such as hives, swelling or wheezing. . In the case of 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 intestine. It is a little-known “food allergy” that occurs mainly in 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,” says Dr. Mar Fernández Nieto, from the Allergology Service of the Jiménez Díaz Foundation University Hospital.
A survey carried out in the US 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 pediatric age, from the neonatal period to four years of age, although more and more cases are being diagnosed in adults. We are facing an underdiagnosed disease, both in children and adults.
In the event that enterocolitis affects infants and children, the foods most involved are those that have been introduced into their diet before, such as milk, eggs and fish, although they are not the only ones since any food, without exception, can be responsible. This varies depending on the geographical location because it depends on the dietary habits of each population.
Enterocolitis, confusing symptoms
In most cases, the symptoms, which appear mainly between one and four hours after ingesting the food allergen, are usually digestive: nausea, vomiting or diarrhea during the first few meals of introducing a new food. According to Fernández Nieto, “the symptoms are worse with each contact and children usually present irritability, crying, probably due to abdominal pain, vomiting, diarrhea and generalized weakness.” In adults, symptoms are more concentrated in crampy abdominal pain, accompanied by vomiting, diarrhea and general malaise.
On the other hand, it does not cause skin rashes or respiratory problems. This means that the 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 related to immunological disorders is its atypical and complex diagnosis since it is not based on traditional allergy tests as it is not a true food allergy. That is, there is no specific immunoglobulin E against the allergen in question. Therefore, the tests that are performed – skin tests, prick-tests and/or blood – to measure IgE levels do not help because they come out negative.
The fact that the reaction is not caused by IgE antibodies means that the diagnosis comes primarily from the exclusion of other diagnoses, both allergy and digestive disorders, celiac disease or infectious diseases, among others. Diagnosis is also made difficult by the fact that there is a latency period between ingestion and the appearance of symptoms, which is longer than in an IgE-mediated allergy. The sum of all these conditions is what makes diagnosis difficult and delays.
Enterocolitis: how it is treated and how it evolves
Currently there is 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 milk in infants, it is necessary to replace it with an adapted formula with a high degree of protein hydrolysis,” says Fernández Nieto. As we have already mentioned, in the pediatric population the symptoms usually disappear around five years of age, something that in adults tends to be more permanent and tends to become chronic.
As the doctor warns, it is possible that “in the allergist’s office, skin and blood tests may be performed because some cases can evolve into a true food allergy with the finding of positive specific IgE” and, depending on the results, it is It is possible that allergists evaluate “the food challenge test in the hospital with informed consent,” says Fernández Nieto.
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