Food Allergy and Intolerance in IBS

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder. IBS is likely to be a multifactorial condition resulting from a number of different mechanisms such as disordered motility, visceral hypersensitivity, abnormal central processing, psychological factors, genetic factors, gut inflammation, and dietary factors. Many patients with IBS give a history of adverse food reactions, but the foods identified to be relevant have been highly variable. Food hypersensitivity can be mediated by immunoglobulin E-dependent and -independent mechanisms involving mast cells, eosinophils, and other immune cells. Recent clinical and experimental studies suggest that there is a possible role for food hypersensitivity in IBS, with improvement of IBS symptom severity in a subset of patients on elimination diets, but the underlying mechanisms in IBS have yet to be fully understood. This review considers the evidence for the role of food hypersensitivity in IBS, based on the available epidemiologic and pathophysiologic data, and the clinical implications.