0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10
584 Food Allergies(complete villous atrophy, extensive cellular infiltrate) and dermati-
tis herpetiformis (less marked changes than celiac sprue)
differential diagnosis
■IgE-mediated hypersensitivity
■Oral allergy syndrome
■GI anaphylaxis
■Allergic eosinophilic gastroenteritis
■Non IgE-mediated hypersensitivity
■Celiac disease
■Dermatitis herpetiformis
■Food intolerance
■Metabolic disorders: idiosyncratic, non-immunologically mediated-
disaccharidase deficiency, G6PD deficiency, hypo- or abetalipopro-
teinemia, acrodermatitis enteropathica
■Toxin induced reaction from mushrooms, botulism, aflatoxins
■Infections: bacterial enterotoxins, postinfectious malabsorp-
tion
■Contaminants: antibiotics, pesticides, dyes, flavorings, preserva-
tives, vasoactive amines
■Other gastrointestinal disorders
➣Allergic eosinophilic gastroenteritis (non-mucosal form)
➣Peptic ulcer disease
➣Cholelithiasis
➣IBD
➣IBS
➣Pancreatic disease
■Psychological illness: phobias, avoidances
■Anatomic abnormalities: Hirschsprung’s disease, ileal stenosis, short
bowel syndrome, intestinal lymphangiectasia
■Tumors: ZE syndrome, neuroblastoma (catecholamines or
VIP)management
What to Do First
■Assess severity of reaction, spectrum from urticaria to shock
■Avoidance of offending food if known
■Use of antihistamines
■Possible use of steroids
■Epinephrine for anaphylaxis