Can food allergy trigger acute pancreatitis? Exploring an unusual etiology

Food allergy (FA) is an immune-mediated hypersensitivity reaction to specific dietary antigens. While FA typically manifests with skin, respiratory, or gastrointestinal symptoms, its role in acute pancreatitis remains unclear. Acute pancreatitis is a potentially life-threatening inflammatory condition with well-known etiologies; however, in up to 30% of cases, no identifiable cause is found, resulting in a diagnosis of idiopathic acute pancreatitis (IAP).

This prospective study aimed to investigate the potential association between FA and IAP in adult patients.

Forty-nine adult patients diagnosed with IAP were evaluated. During the acute episode, serum tryptase, total immunoglobulin E (IgE), and eosinophil levels were measured. Eight weeks post-recovery, skin prick tests (SPT) and serum-specific IgE (sIgE) tests were performed for common and suspected food allergens. Patients with positive results underwent further testing, including prick-to-prick testing.

Among 49 patients, eight (16.3%) demonstrated sensitization to food allergens, such as cow's milk, wheat, red meat, banana, plum, and tomatoes. These patients had significantly higher total IgE levels (P = 0.001). No significant differences were found in attack severity or tryptase levels between FA and non-FA groups. One patient experienced recurrence after re-exposure to the identified allergen. SPT alone failed to detect sensitization in several cases, whereas sIgE and prick-to-prick tests improved diagnostic accuracy.

This is the first prospective study to suggest a potential link between FA and IAP. In cases of unexplained pancreatitis, FA should be considered in the differential diagnosis. Multidisciplinary collaboration between gastroenterologists and allergists is recommended for accurate diagnosis and management.