Protein Intolerance, Medical Journal Article review by Joy

http://emedicine.medscape.com/article/931548-overview

The Medical Journal Article on Protein Intolerance article (last updated April 2010) provides a full overview of the many manifestation of protein intolerance's. Discussions of IgE and Non-IgE Protein intolerance with a focus on GI symptoms being the most common in children with reactivity to food proteins.


The article outlines a basic discussion on oral tolerance and the immunologic and inflammatory mechanisms related to this process.   "Under normal circumstances, food antigen exposure via the GI tract results in a local immunoglobin A (IgA) response and in activation of suppressor CD8+ lymphocytes that reside in the gut-associated lymphoid tissue (Oral tolerance).  In some children who are genetically susceptible, or for other as-of-yet unknown reasons, oral tolerance does not develop and different immunologic and inflammatory mechanisms can be elicited".

Other points of interest:

• Food protein intolerance's can be IgE or Non-IgE mediated, studies have shown the role of gut T cell lymphocytes in the development of GI food allergy. 
• Mention here of IgG antibodies, but that their role is still not clear.  
• Protein Intolerance's generally resolve by age 5, with the maturing of the mucosal immune system. 
• A table is included to classify adverse reactions to foods. 
• With food protein intolerance's, GI symptoms are most commonly presented and can include:
  • Oral Allergy Syndrome (IgE)
  • Immediate GI hypersensitivy (IgE)
  • Eosinophilic esophagitis, Eosinophilic gastrities, Eosinophilic gastroenteritis (IgE and Non-IgE)
  • Food Protein Induced Enterocolitis
  • Food-induced enteropathy
  • Gluten-sensitive enteropathy
  • Protein-losing enteropathy
  • Food-Induced Proctocolitis
  • Food-Allergy induced gastroesophageal reflux (GERD)
  • Chronic constipation
  • Colic
  • Allergic dysmotility
  • Multiple Food protein intolerance of infancy
  • Dermatologic symptoms
  • Respiratory symptoms
  • General and non-specific symptoms are also recognized.