Gastrointestinal Disorders

Some disorders may produce symptoms that are similar to those of food allergies. However, some related digestive diseases are conditions that do not involve IgE (immunoglobulin E), the antibody that causes potentially life-threatening reactions in people with food allergies. Our team of allergists is extremely experienced in managing patients with these diseases, and works closely with your primary healthcare provider or gastroenterologist to customize effective therapy for you or your child.

Eosinophilic Esophagitis (EoE)

Our doctors care for a large number of patients with eosinophilic esophagitis (EoE). Eosinophilic esophagitis (EoE) causes large numbers of eosinophils, a type of white blood cell, to gather in the esophagus (the tube that connects the mouth to the stomach). As a result, the lining of the esophagus becomes inflamed, making it difficult for food to go down. EoE can be triggered by certain foods. Symptoms vary, depending on age. With infants and toddlers, families often note feeding difficulties, irritability, and occasionally poor weight gain. Older children typically have regurgitation, vomiting, heartburn and “belly pain.” Teenagers and adults may have chest pain, difficulty swallowing and a feeling that food “gets stuck” when they swallow. Some individuals complain that it takes a long time to eat meals and that large quantities of water are needed to help swallow food. They may also complain of feeling full rapidly and may stop eating before finishing a meal. Once a diagnosis of EoE is confirmed, food allergy testing is typically performed to determine if a food is triggering the condition. To learn more about EoE, please visit the website of the American Partnership for Eosinophilic Disorders.

Food Protein-induced Enterocolitis Syndrome (FPIES)

One of the more common allergy-related diseases we treat is milk protein allergy, which typically affects infants after the first few weeks of life. Food protein-induced enterocolitis syndrome(FPIES) is a serious, non-IgE-mediated type of food allergy. FPIES is usually triggered by cow’s milk or soy, though some cereal grains, especially rice and oat, and other foods may cause it. The symptoms typically include severe vomiting and diarrhea. Reactions are often delayed by 2-3 hours after the trigger food is eaten. Standard food allergy tests are not used for diagnosing FPIES. The primary test medical professionals use to diagnose this disease is an oral food challenge with the suspected trigger food. In most cases, FPIES is resolved by the age of three. More information about FPIES is available from the FPIES Foundation and the International Association for Food Protein Enterocolitis.

Oral Allergy Syndrome (OAS)

Oral allergy syndrome (OAS), also known as pollen-food syndrome, is a term used to describe itchy or scratchy mouth symptoms caused by raw fruits or vegetables in people who also have hay fever. Symptoms are typically limited to the mouth. This reaction is caused by an allergic response to the pollen that crosses over to similar proteins in the foods. Because these proteins are sensitive to heating, most people affected by OAS can eat cooked fruits or vegetables. Symptoms usually resolve within minutes after the food is swallowed or removed from the mouth, and treatment generally is not necessary. OAS typically presents in older children, teens or young adults. Often, patients have been eating the offending foods without problems for many years. Common pollen-food associations* • Birch: apple, carrot, peach, plum, cherry, pear, almond, hazelnut • Grasses: tomato • Ragweed: melons, zucchini, cucumber, kiwi, banana * These are potential associations. Not every individual allergic to pollen develops symptoms with cross-reacting fruits or vegetables. Individuals may react to a few but not all of the above.

Food Intolerance

With the exception of celiac disease (see below), food intolerances do not involve the immune system. Although food intolerances may cause some of the same symptoms as a true food allergy, they cannot trigger anaphylaxis, a potentially life-threatening reaction. Common intolerances include:

Lactose Intolerance

Lactose intolerance occurs when a person’s small intestine does not produce enough of the lactase enzyme. As a result, affected individuals are not able to digest lactose, a type of sugar found in dairy products. The symptoms of lactose intolerance typically occur within 30 minutes to two hours after ingesting dairy products. Large doses of dairy may cause increased symptoms.

Celiac Disease

An adverse reaction to gluten is known as celiac disease or “celiac sprue.” This chronic digestive disease requires a lifelong restriction of gluten, which is found in wheat, rye, barley, and perhaps oats. People with celiac disease must strictly avoid these grains and their by-products. When people with celiac disease eat gluten, they experience an immune reaction in the small intestine. IgE, the antibody responsible for life-threatening reactions (anaphylaxis) does not play a role in this disorder. However, the immune response in celiac disease may damage the lining of the small intestine, preventing proper absorption of the nutrients in food. Over time, patients may become malnourished. Celiac disease can cause many symptoms, including bloating and gas, diarrhea, constipation, headaches, itchy skin rash, and pale mouth sores, to name a few. The symptoms may vary among affected individuals. More information about celiac disease is available from the Celiac Disease Foundation and the National Foundation for Celiac Awareness.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults. People with asthma are at higher risk of developing GERD.  Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms.  On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

Symptoms Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth or have heartburn. However, if these symptoms interfere with your daily life it is time to see your physician.nOther symptoms that occur less frequently but can indicate that you could have GERD are: acid regurgitation (retasting your food after eating), difficulty or pain when swallowing, sudden excess of saliva, chronic sore throat, laryngitis or hoarseness, inflammation of the gums, cavities, bad breath, chest pain (seek immediate medical help).

Diagnosis Several tests may be used to diagnose GERD including: x-ray of the upper digestive system, x-ray of the upper digestive system, endoscopy (examines the inside of the esophagus), ambulatory acid (pH) test (monitors the amount of acid in the esophagus), esophageal impedance test (measures the movement of substances in the esophagus).

If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease.

Lifestyle changes to treat GERD include: elevate the head of the bed 6-8 inches, lose weight, stop smoking, decrease alcohol intake, limit meal size and avoid heavy evening meals, do not lie down within two to three hours of eating,  decrease caffeine intake, avoid theophylline (if possible). Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.In severe and medication intolerant cases, surgery may be recommended.

Consult an Allergist

A person could possibly have both a food allergy and a related condition, such as eosinophilic esophagitis. Patients with allergy-related gastrointestinal disease may often have other allergic diseases, such as eczema or asthma. Our allergists can help with diagnosis of your symptoms and create an individualized treatment plan for you. To make an appointment, please call us at 205-871-9661.