Gastrointestinal immunopathology and food allergy

To review the current data that support the pivotal function of the gastrointestinal immune system in health and disease and its critical role in the pathogenesis of a wide variety of clinical disorders associated with food allergy (FA).

Internet-based literature search and our own data.

The studies included in this review were selected based on the expert opinion of the authors.

In contrast to the beneficial expressions of gastrointestinal-associated lymphoid tissue, which are seen with relevance to newer methods of delivery of vaccines directly applied to the gastrointestinal mucosal surfaces (eg, oral poliovirus, rotavirus, Salmonella typhi vaccines), the adverse consequences of a mucosal immune response gone astray are evidenced in many diseases such as FA. A classification of clinical disorders associated with FA based on classic mechanisms of immunologic injury is presented, which includes the following: (1) IgE-mediated, (2) non-IgE-mediated, and (3) mixed IgE- and non-IgE-mediated disorders. Our study of immunologic disturbance in patients with non-IgE FA revealed a pattern of increased CD4+ and decreased TH1 cell counts in peripheral blood mononuclear cells in contrast to patients with celiac disease, where a pattern of increased CD8+ and TH1 cell counts in peripheral blood mononuclear cells and increased CD8+ cell counts was seen.

The gastrointestinal immune response thus plays a pivotal role in maintaining protective immunity in health and a critical role in the pathogenesis of a wide variety of clinical disorders associated with FA.