What is a Non-IgE Food Allergy? By the PIC Team

A Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food that are either IgE or Non-IgE mediated.  Food Allergy is now being increasingly recognized as classified, IgE and/or Non-IgE mediated.

IgE stands for Immunoglobin E, a measurable antibody producing immune response to a food protein.  Symptoms are immediate onset (0-2hrs within ingestion) and can include, but not limited to: hives, sneezing, wheezing, itching, red eyes, throat swelling, allergic asthma, and severe reactions can include rapid heart rate, low blood pressure, anaphylaxis (see table below).   The most common ("top 8") food allergens include: eggs, milk, peanut, tree nut, wheat, shellfish, and soy but are not limited to these foods,  any food with a protein can elicit an allergic reaction.  Also included in the immediate immune response is Oral Allergy Syndrome (OAS) and some components of Eosinophilic disorders (EGID).

A Non-IgE Allergy is cell-mediated (vs.antibody) and defined by a delayed response of the immune system, typically involving the gut.  No measurable antibodies are produced, symptoms are delayed (2+hours from ingestion) and include, but not limited to: sneezing, itching, runny nose, asthma, reflux, colic, abdominal pain, nausea, vomiting and diarrhea, and severe reactions can include lethargy, hypotension, and shock (see table below).  Like IgE allergies, the "Top 8" are included but are not limited in Non-IgE food allergies as any food protein can elicit this response.  Diagnosis included in this immune response are: Milk/Soy Protein intolerance, Multiple Food Protein Intolerance, Food Protein-Induced Procolitis, Food Protein Induced Enterocolits, Food Protein Enteropathy, Celiac Disease, and Eosinophilic Disorders.



IgE FOOD ALLERGY:
(Typical food allergy)
Immediate onset reactions
Mediated by production of Immunoblogin E antibodies in response to a food, usually a protein.
Common Conditions*:
1.IgE food allergy (ie egg, milk, peanut, tree nut, soy, wheat, shell fish…)
2.Eosinophilic Disorders
3.Oral Allergy Syndrome
 *list is not inclusive, please see your doctor for any symptoms/diagnosis

Common Respiratory Symptoms:
·Sneezing, runny nose, congestion, hay fever
·Shortness of breath
·Throat swelling
·Cough
·Allergic asthma
·Pink eye/eye swelling

COMMON GI SYMPTOMS:

• Nausea/Vomiting/Diarrhea
• Cramping abdominal pain
• Reflux/Difficulty swallowing
• Swelling (tongue,lips,face)
• Itching/swelling of the tongue, lips, mouth
• Dizziness
• Fainting

Severe reactions (anaphylaxis) can be life threatening and require immediate medical attention and can include:

• Itching or tightness in the throat
• Difficulty breathing
• Wheezing/coughing
• Rapid heart rate
• Low blood pressure
• Loss of consciousness

Symptoms usually occur within minutes to 1-2 hours after ingesting the food.

Common skin symptoms:
·Eczema
·Hives
·Rashes (dermatitis)
Diagnostic Tests:
·RAST (serum IgE)
·Skin Prick Testing
·EE requires endoscopy




NON- IgE FOOD ALLERGY: (PROTEIN INTOLERANCE)
Delayed onset reactions
Mediated by non-IgE antibodies and/or cellular immune responses to a food-protein.
Common conditions*:
1.Milk/Soy Protein Intolerance
2.Multiple Food Protein Intolerance
3.Food protein-Induced Allergic Protocolitis
4.Food Protein Induced Enterocolitis Syndrome
5.Food Protein Enteropathy
6.Celiac Disease (also auto-immune)
7.Eosinophilic Disorders (also IgE)
*list is not inclusive, please see your doctor for any symptoms/diagnosis


Common Respiratory Symptoms:
·Non-allergic sneezing, congestion, runny nose
·Non-atopic cough, asthma
·Recurrent or chronic sinus inflammation/infections
·Reflux disease
·Recurrent ear infections
·Eye swelling
·Enlarged adenoids
  
COMMON GI SYMPTOMS

• Mucus/Blood in Stools
• Inconsolable and Extended Crying/Colic
• Disrupted Sleep
• Malabsorption/Vitamin Deficiency
• "Spit-up" an hour+ after feeding
• Sulfur/sour smelling stools
• Diarrhea and/or constipation
• Red ring around bottom (diaper) 
• Peeling diaper rash
• Gas/wind
• Mouth itching
• Dysbiosis

Symptoms can occur hours to days after ingesting the food.

Severe reactions can be life threatening (FPIES) and require immediate medical attention and can include:

• Loss of appetite
• Violent/forceful/projectile vomiting
• Lethargy
• Diarrhea
• Dehydration
• Low body temp or fever
• Low blood pressure
• Shock

Common skin symptoms:
·Eczema
·Rashes/flushing
·Itchy skin
·Diaper rash.
  
Diagnostic Tests:
·Medical history
·Food elimination and challenge
·Endoscopy/colonoscopy
 Atopy Patch Testing


References:

1. Guidelines for Diagnosis and Management of Food Allergy in the United States (2010)
2. Medical Journal Article on Protein Intolerance (April 2010)
3. Nonimmunoglobin E-Mediated Immune Reactions to Foods by Dr.Spergel (2006)
4. Non-Ige Food Allergy by Dr. Jyonouchi (2008)
5. Food Allergy: Review, Classification and Diagnosis by Dr.Spergel & Dr.Cianferoni (2009)