Main Article Content
Irritable bowel syndrome, IBS, delayed-type hypersensitivity, type 4 hypersensitivity, patch testing, food allergy, skin tests
Irritable Bowel Syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology.
We sought to investigate whether specific type 4 food allergens identified by skin patch testing, when eliminated from the diet, alleviate symptoms of IBS.
In this case series, skin patch testing was performed on 60 IBS patients using an extensive panel of type 4 food allergens after which food avoidance diets directed by the patch test results were implemented. Questionnaires assessing abdominal pain/discomfort and global improvement in IBS symptoms were used to assess one month and three or more month outcomes.
There were statistically significant improvements in abdominal pain/discomfort and in global IBS symptoms after one month and again at an average of 7.6 months of patch test-guided food avoidance.
Sustained improvement with avoidance of type 4 food allergens identified by skin patch testing suggests a role for delayed-type food hypersensitivities in the pathogenesis of some cases of IBS. A subset of patients whose IBS symptoms resolve completely may be better characterized as having a newly proposed disease, allergic contact enteritis (ACE).
2. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011;12:453-463.
3. Spiller R. Irritable bowel syndrome: new insights into symptom mechanisms and advances in treatment. F1000Research,
2016; Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856111/. Accessed June 25, 2016.
4. Chadwick VS, Chen W, Shu D, et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology. 2002;122:1778-1783.
5. Tornblom H, Lindberg G, Nyberg B, Veress B. Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. Gastroenterology. 2002;123:1972-1979.
6. O'Mahony L, McCarthy J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541-551.
7. Grover M, Herfarth H, Drossman DA.The Functional–Organic Dichotomy: Postinfectious Irritable Bowel Syndrome and Inflammatory Bowel Disease–Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2009;7:48-53.
8. Chey WD. Food: The Main Course to Wellness and Illness in Patients with Irritable Bowel Syndrome. Am J Gastroenterol. 2016;111:366-371.
9. Gibson PR, Varney J, Malakar S, Muir JG. Food components and irritable bowel syndrome. Gastroenterology. 2015;148:1158-74.e4.
10. Tilg H, Moschen AR. Food, immunity, and the microbiome. Gastroenterology. 2015;148:1107-1119.
11. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480-1491.
12. Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immun. 2010;126:S1-58.
13. Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based systematic review on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104:S1-35.
14. Rietschel RL, Fowler JF. Fisher's Contact Dermatitis. Hamilton, Ontario (Canada):BCDecker; 2008.
15. Stierstorfer MB, Sha CT, Sasson M. Food patch testing for irritable bowel syndrome. J Am Acad Dermatol. 2013;68:377-384.
16. Rome Foundation. Guidelines--Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. J Gastrointestin Liver Dis. 2006;15:307-312.
17. DeGroot AC. Patch Testing. The Netherlands:ACDeGroot Publishing; 2008.
18. Marks JG, Belsito DV, DeLeo MD, et al. North American Contact Dermatitis Group patch test results for the detection of delayed-type hypersensitivity to topical allergens. J Am Acad Dermatol. 1998;38:911-918.
19. Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146:67-75.e5.
20. Hrobiartsson A, Gotzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med 2001;344:1594-1602.
21. Ford AC, Moayyedi P. Meta-analysis: factors affecting placebo response rate in the irritable bowel syndrome. Aliment Pharmacol Ther 2010;32(2):144-158.
22. Spiller RC. Problems and challenges in the design of irritable bowel syndrome clinical trials: experience from published trials. Am J Med 1999;107:91S-97S