About Protein Induced Conditions

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	Non- IgE Food Allergy: (PROTEIN INTOLERANCE) Delayed onset reactions
The body's abnormal immune response to a food, usually a protein.	Mediated by non-IgE antibodies and/or cellular immune responses.
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 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:             Sneezing, runny nose, congestion, hay fever             Shortness of breath            Throat swelling             Cough             Allergic asthma           Pink eye/eye swelling	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: 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 GI SYMPTOMS for MSPI/MFPI: 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 the anus Peeling diaper rash Gas/wind Mouth itching Dysbiosis Symptoms can occur hours to days after ingesting the food. COMMON SYMPTOMS for FPIES will include above and: Loss of appetite Violent/forceful/projectile vomiting Lethargy Dehydration Low body temp or fever Low blood pressure Shock For more information on: Celiac (hyperlink sites) EE disorders (hyperlinks)
Common skin symptoms: Eczema Hives Rashes (dermatitis)	Common skin symptoms:             Eczema             Rashes/flushing             Itchy skin             Diaper rash.
Diagnostic Tests: RAST (serum IgE) Skin Prick Testing (SPT) EE requires endoscopy	Diagnostic Tests/Tools: Atopy Patch Testing Food elimination and challenge Endoscopy/colonoscopy Medical history

Many children will experience both allergies and intolerances. It is important to see your pediatrician if your child is experiencing any of these symptoms. 

Information put together by parents of protein intolerant children. 

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)