Diagnóstico diferencial en alergia alimentaria
PDF
XML

Palabras clave

Alergia alimentaria
Diagnóstico diferencial
Reacciones tóxicas
Intolerancia alimentaria
Síntomas gastrointestinales
Epinefrina

Cómo citar

Diagnóstico diferencial en alergia alimentaria. (2023). Revista Alergia México, 70(4), 260-264. https://doi.org/10.29262/ram.v70i4.1312

Resumen

Es importante establecer el diagnóstico diferencial de alergia alimentaria con otras alteraciones, por ejemplo: reacciones tóxicas que ocurren en cualquier persona expuesta a una cantidad suficiente de algún alérgeno, y reacciones no tóxicas que dependen de la susceptibilidad individual (alergia o intolerancia alimentarias). El diagnóstico diferencial es decisivo para establecer el tratamiento adecuado. La intolerancia alimentaria implica reacciones adversas a alimentos sin ninguna respuesta inmunológica implicada, y comúnmente se manifiesta con síntomas gastrointestinales (malestar, dolor abdominal o diarrea). La alergia alimentaria es una reacción exagerada del sistema inmunológico, a menudo mediada por IgE, que puede desencadenar síntomas graves (urticaria, inflamación, dificultad respiratoria, incluso anafilaxia). Lo complejo es porque los síntomas a veces se superponen. Para establecer el diagnóstico certero se requiere la evaluación clínica exhaustiva, pruebas de laboratorio y, en algunos casos, pruebas de provocación controladas. Es importante comprender estas distinciones, porque el tratamiento y la gestión varían significativamente. La intolerancia alimentaria implica la eliminación o reducción del alimento desencadenante de la reacción alérgica y requiere medidas rigurosas (evitar por completo el alérgeno y disponibilidad de epinefrina en casos de reacciones graves).

PDF
XML

Referencias

Diagnóstico diferencial en alergia alimentaria

Solymosi D, Sárdy M, et al. Interdisciplinary Significance of Food-Related Adverse Reactions in Adulthood. Nutrients 2020; 12 (12): 3725.

Sampson HA. Historical Background, Definitions and Differential Diagnosis. In: Ebisawa M, Ballmer-Weber BK, Vieths S, Wood RA, editors. Chemical Immunology and Allergy. S. Karger AG; 2015: 1-7.

Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2018; 141 (1): 41-58.

Sánchez J, Sánchez A. Epidemiologic studies about food allergy and food sensitization in tropical countries. Results and limitations. Allergol Immunopathol (Madr) 2019; 47 (4): 401-8.

Bird JA, Crain M, et al. Food Allergen Panel Testing Often Results in Misdiagnosis of Food Allergy. J Pediatr 2015; 166 (1): 97-100.e1.

Gargano D, Appanna R, et al. Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients 2021; 13 (5): 1638.

Sampson HA, Aceves S, et al. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134 (5): 1016-1025.e43.

Cosme-Blanco W, Arroyo-Flores E, et al. Food Allergies. Pediatr Rev 2020; 41 (8): 403-15.

Sampson H. Differential diagnosis in adverse reactions to foods. J Allergy Clin Immunol 1986; 78 (1): 212-9.

Cárdenas-Torres FI, Cabrera-Chávez F, et al. Non-Celiac Gluten Sensitivity: An Update. Medicina (Mex) 2021; 57 (6): 526.

Leonard MM, Sapone A, et al. Celiac Disease and Nonceliac Gluten Sensitivity: A Review. JAMA 2017; 318 (7): 647-56.

Skodje GI, Sarna VK, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154 (3): 529-539.e2.

Bellini M, Tonarelli S, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12 (1): 148.

Vernon-Roberts A, Alexander I, et al Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J Clin Med 2021; 10 (21): 5087.

Bock SA, Sampson HA. Evaluation of Food Allergy. In: Pediatric Allergy: Principles and Practice. Elsevier; 2016: 371-376.e2.

Feng C, Teuber S, Gershwin ME. Histamine (Scombroid) Fish Poisoning: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 50 (1): 64-9.

Navale V, Vamkudoth KR, et al. Aspergillus derived mycotoxins in food and the environment: Prevalence, detection, and toxicity. Toxicol Rep 2021; 8: 1008-30.

Ruiz Sánchez JG. Una Visión Global de las reacciones adversas a alimentos: alergia e intolerancia alimentaria. Nutr Hosp 2018; 35 (4).

Di Costanzo M, Berni Canani R. Lactose Intolerance: Common Misunderstandings. Ann Nutr Metab 2018; 73 (Suppl 4): 30-7.

Kirby TO, Ochoa-Reparaz J, et al. Dysbiosis of the intestinal microbiome as a component of pathophysiology in the inborn errors of metabolism. Mol Genet Metab 2021; 132 (1): 1-10.

Valluzzi RL, Fierro V, et al. Allergy to food additives. Curr Opin Allergy Clin Immunol 2019; 19 (3): 256-62.

Gómez-Gómez L, Feo-Brito F, et al. Involvement of lipid transfer proteins in saffron hypersensitivity: molecular cloning of the potential allergens. J Investig Allergol Clin Immunol 2010; 20 (5): 407-12.

Lemoine A, Pauliat-Desbordes S, et al. Adverse reactions to food additives in children: A retrospective study and a prospective survey. Arch Pédiatrie 2020; 27 (7): 368-71.

San Mauro Martin I, Brachero S, et al. Histamine intolerance and dietary management: A complete review. Allergol Immunopathol (Madr) 2016; 44 (5): 475-83.

Fiocchi A, Claps A, et al. Differential diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol 2014; 14 (3): 246-54.

Caminero A, Meisel M, et al. Mechanisms by which gut microorganisms influence food sensitivities. Nat Rev Gastroenterol Hepatol 2019; 16 (1): 7-18.

Buyuktiryaki B, Sekerel BE. Is It Food Allergy or Frey Syndrome? J Allergy Clin Immunol Pract 2015; 3 (2): 269-70.

Giovannini-Chami L, Blanc S. Frey’s syndrome: differential diagnosis of food allergy. Arch Dis Child 2014; 99 (5): 457.

Smith A, Jonas N. Frey’s Syndrome. N Engl J Med 2020; 382 (15): 1456-1456.

Hellings PW, Klimek L, et al. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2017; 72 (11): 1657-65.

Bacanli M, Başaran N. Importance of antibiotic residues in animal food. Food Chem Toxicol Int J Publ Br Ind Biol Res Assoc 2019; 125: 462-6.

Intolerancia alimentaria

Gargano D, Appanna R, et al. Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients 2021; 13 (5): 1638. doi:10.3390/nu13051638

Lomer, M.C. Review article: The aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther 2015; 41: 262-275.

Jansson-Knodell CL, White M, et al. High prevalence of food intolerances among us internet users. Public Health Nutr 2021; 24: 531-535.

Panel NSE, Boyce JA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126: S1-S58.

Werfel T. Skin manifestations in food allergy. Allergy 2001; 56: 98-101.

Cardinale F, Mangini F, et al. Intolerance to food additives: An update. Minerva Pediatr 2008; 60: 1401-1409.

Tuck CJ, Biesiekierski JR, et al. Food Intolerances. Nutrients 2019; 11: 1684.

Halpern GM, Scott JR. Non-Ige antibody mediated mechanisms in food allergy. Ann Allergy 1987; 58: 14-27.

Reese I, Ballmer-Weber B, et al. German guideline for the management of adverse reactions to ingested histamine: Guideline of the german society for allergology and clinical immunology (DGAKI), the german society for pediatric allergology and environmental medicine (GPA), the german association of allergologists (AEDA), and the Swiss society for allergology and immunology (SGAI). Allergo J Int 2017; 26: 72-79.

Vally H, Misso NL. Adverse reactions to the sulphite additives. Gastroenterol Hepatol Bed Bench 2012; 5: 16-23.

Schnedl WJ, Lackner S, et al. Evaluation of symptoms and symptom combinations in histamine intolerance. Intest Res 2019; 17: 427-433.

Andreozzi L, Giannetti A, et al. Hypersensitivity reactions to food and drug additives: Problem or myth? Acta Biomed 2019; 90: 80-90.

Kettner L, Seitl I, et al. Evaluation of porcine diamine oxidase for the conversion of histamine in food-relevant amounts. J Food Sci 2020; 85: 843-852.

San Mauro Martin I, Brachero S, et al. Histamine intolerance and dietary management: A complete review. Allergol Immunopathol 2016; 44: 475-483.

Deng, Y.; Misselwitz, B.; et al ; Lactose intolerance in adults: Biological mechanism and dietary management. Nutrients 2015; 7: 8020-8035.

Enattah N, Pekkarinen T, et al. Genetically defined adult-type hypolactasia and self-reported lactose intolerance as risk factors of osteoporosis in finish postmenopausal women. Eur J Clin Nutr 2005; 59: 1105-1111.

Montalto M, Nucera G, et al. Effect of exogenous beta-galactosidase in patients with lactose malabsorption and intolerance: A crossover double-blind placebo-controlled study. Eur J Clin Nutr 2005; 59: 489-493.

Major G, Pritchard S, et al. Colon hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in individuals with irritable bowel syndrome. Gastroenterol 2017; 152: 124-133.e122.

Murray K, Wilkinson-Smith V, et al. Differential effects of fodmaps (fermentable oligo-, di-, monosaccharides and polyols) on small and large intestinal contents in healthy subjects shown by mri. Am J Gastroenterol 2014; 109: 110-119.

Bucci C, Zingone F, et al. Gliadin does not induce mucosal inflammation or basophil activation in patients with nonceliac gluten sensitivity. Clin Gastroenterol Hepatol 2013; 11: 1294-1299.e1291.

Misselwitz B, Butter M, et al. Update on lactose malabsorption and intolerance: Pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-2091.

Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr 1996; 64: 232-236.

Zingone F, Bucci C, et al. Consumption of milk and dairy products: Facts and figures. Nutrition 2017; 33: 322-325.

Laniro G, Pecere S, et al. Digestive enzyme supplementation in gastrointestinal diseases. Curr Drug Metab 2016; 17: 187-193.

Catassi C, Elli L, et al. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria. Nutrients 2015; 7: 4966-4977.

Biesiekierski JR, Newnham ED, et al. Characterization of Adults with a Self-Diagnosis of Nonceliac Gluten Sensitivity. Nutr Clin Pract 2014; 29: 504-509.

Varjú P, Farkas N, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies. PLoS ONE 2017; 12: e0182942.

Hookway C, Buckner S, et al. Irritable bowel syndrome in adults in primary care: Summary of updated nice guidance. BMJ 2015; 350: h701.

Stockhorst U, Enck P, et al. Role of classical conditioning in learning gastrointestinal symptoms. World J Gastroenterol 2007; 13: 3430-3437.

Santonicola A, Siniscalchi M, et al. Prevalence of functional dyspepsia and its subgroups in patients with eating disorders. World J Gastroenterol 2012; 18: 4379-4385.

Santonicola A, Gagliardi M, et al. Anhedonia and functional dyspepsia in obese patients: Relationship with binge eating behaviour. World J Gastroenterol 2020; 26: 2632-2644.

Alergia alimentaria no mediada por IgE

Cianferoni A. Non-IgE Mediated Food Allergy. Curr Pediatr Rev 2020; 16 (2): 95-105. doi: 10.2174/1573396315666191031103714.

Zhang S, Sicherer S, Berin MC, Agyemang A. Pathophysiology of Non-IgE-Mediated Food Allergy. Immunotargets Ther 2021; 29 (10): 431-446. doi: 10.2147/ITT.S284821.

Mennini M, Fierro V, Di Nardo G, Pecora V, et al. Microbiota in non-IgE-mediated food allergy. Curr Opin Allergy Clin Immunol 2020; 20 (3): 323-328.

Tordesillas L, Berin MC, Sampson HA. Immunology of Food Allergy. Immunity 2017; 47 (1): 32-50. doi: 10.1016/j.immuni.2017.07.004.

Labrosse R. Graham F, Caubet JC. Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update. Nutrients 2020. 2020; 12 (7): 2086. doi: 10.3390/nu12072086.

Nowak-Węgrzyn A, Chehade M, Groetch ME, Spergel JM, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Commitee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2017; 139 (4): 1111-1126. doi: 10.1016/j.jaci.2016.12.966. Epub 2017 Feb 4.

Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child 2009; 94: 425-428.

Sopo SM, Giorgio V, Iacono ID, Novembre E, et al. A multicenter retrospective study of 66 Italian children with food protein-induced enterocolitis syndrome: different management for different phenotypes. Clin Exp Allergy 2012; 42: 1257-65. doi: 10.1111/j.1365-2222.2012.04027.x.

Mehr S, Frith K, Barnes EH, Campbell DE, et al. Food protein–induced enterocolitis syndrome in Australia: A population-based study, 2012–2014. J. Allergy Clin Immunol 2017; 140: 1323-1330.

Rostami MN; Douraghi M, Mohammadi AM, Nikmanesh B. Altered serum pro-inflammatory cytokines in children with Down’s syndrome. Eur Cytokine Netw 2012; 23: 64-67. doi: 10.1684/ecn.2012.0307.

Tan JA, Smith WB. Non-IgE-mediated gastrointestinal food hypersensitivity syndrome in adults. J Allergy Clin Immunol Pract 2014; 2 (3): 355-7.

Kimura M, Ito Y, Shimomura M, Morishita H, et al. Cytokine profile after oral food challenge in infants with food protein-induced enterocolitis syndrome. Allergol Int. 2017; 66(3): 452-457. doi: 10.1016/j.alit.2016.12.001.

Caubet JC, Szajewska H, Shamir R, Nowak-Węgrzyn A. Non-IgE -mediated gastrointestinal food allergies in children. Pediatr Allergy Immunol. 2017; 28(1): 6-17.

Goswami R, Blazquez AB, Kosoy R, Rahman A, et al. Systemic innate immune activation in food protein-induced enterocolitis syndrome. J Allergy Clin Immunol 2017; 139 (6): 1885-1896.

Morita H, Nomura I, Orihara K, Yoshida K, et al. Antigen specific T-cell responses in patients with non-IgE-mediated gastrointestinal food allergy are predominantly skewed to T(H)2. J Allergy Clin Immunol 2013; 131: 590-592.

Mori F, Barni S, Cianferoni A, Pucci N, et al. Cytokine expression in CD3+ cells in an infant with food protein-induced enterocolitis syndrome (FPIES): case report. Clin Dev Immunol. 2009; 2009: 679381. doi: 10.1155/2009/679381.

Adel-Patient K, Lezmi G, Castelli FA, et al. Deep analysis of immune response and metabolic signature in children with food protein induced enterocolitis to cow’s milk. Clin Transl Allergy 2008; 8 (38). doi: 10.1186/s13601-018-0224-9. eCollection 2018.

Berin MC, Lozano-Ojalvo D, Agashe C, Baker MG, et al. Acute FPIES reactions are associated with an IL-17 inflammatory signature. J Allergy Clin Immunol 2021; 148 (3): 895-901.

Katz Y, Goldberg MR, Rajuan N, Cohen A, et al. The prevalence and natural course of food protein-induced

enterocolitis syndrome to cow’s milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011; 127: 647-653.e1-3. doi: 10.1016/j.jaci.2010.12.1105.

Boyer J, Scuderi V, Keene NH. Comparison of the gut microbiome between food protein-induced enterocolitis syndrome (FPIES) infants and allergy-free infants. Ann Allergy Asthma Immunol 2017; 119: e3.

Baker MG, Berin MC, Sicherer S. Update on Food Protein-Induced Enterocolitis Syndrome (FPIES). Curr Allergy Asthma Rep 2022; 22 (10): 113-122.

Hofmann NV, Ahmed A, Fortunato JE. Food protein-induced enterocolitis syndrome: dynamic relationship among gastrointestinal symptoms, immune response, and the autonomic nervous system. Ann Allergy Asthma Immunol 2021; 126 (5): 498-505.

Ono HK, et al. Histamine release from intestinal mast cells induced by staphylococcal enterotoxin A (SEA) evokes vomiZng refex in common marmoset. PLoS Pathog 2019; 15 (5): e1007803.

Jarvinen K, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome: current management strategies. J Allergy Clin Immunol Pract 2013; 1 (4): 317-22. doi: 10.1016/j.jaip.2013.04.004.

Miceli Sopo S, Gelsomino M, Rivep S, Del Vescovo E. Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions. Medicina 2019; 55 (6): 216.

Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol 2005; 115: 149-56.

Burks AW, Tang M, Sicherer S, Muraro A, et al. ICON: food allergy. J Allergy Clin Immunol. 2012; 129: 906-20.

Miceli Sopo S, Greco M, Monaco S, Tripodi S, Calvani M. Food protein-induced enterocolitis syndrome, from practice to theory. Exp Rev Clin Immunol. 2013; 9: 707-15. doi: 10.3390/medicina55060216.

Gonzalez-Delgado P, Ruano-Zaragoza M, Gutierrez A, Lopez F, et al. Chronic adult food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol. 2020; 125 (6): 716-7. doi: 10.1016/j.anai.2020.08.009.

Kuitunen P, Visakorpi JK, SavilahZ E, Pelkonen P. Malabsorption syndrome with cow’s milk intolerance. Clinical findings and course in 54 cases. Arch Dis Child 1975; 50 (5): 351-356.

Barni S, Giovannini M, Mori F. Epidemiology of non-IgE-mediated food allergies: what can we learn from that? Curr Opin Allergy Clin Immunol 2021; 21(2): 188-194.

Beyer K, Castro R, Birnbaum A, Benkov K, et al. Human milk specific mucosal lymphocytes of the gastrointestinal tract display a TH2 cytokine profile. J Allergy Clin Immunol 2002; 109(4): 707-713.

Kokkonen J, HaapalahZ M, Laurila K, Karbunen TJ, et al. Cow’s milk protein sensitive enteropathy at school age. J Pediatr 2001; 139 (6): 797-803.

Savilahti JE. Food-induced malabsorption. J Pediatr Gastroenterol Nutr Pediatr Gastroenterol 2000; 30: S61-S66. doi: 10.1097/00005176-200001001-00010.

Meyer R, Lozinsky AC, Fleischer DM, Vieira MC, et al. Diagnosis and management of Non-IgE gastrointestinal allergies in breassed infants – an EAACI position paper. Allergy. 2020; 75: 14-32. doi: 10.1111/all.13947.

American College of Allergy, Asthma, and Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006; 96 (Suppl 2): S1-S68.

Martin VM, Virkud YV, Phadke NA, et al. Increased IgE-mediated food allergy with food protein-induced allergic proctocolitis. Pediatrics 2020; 146 (3).

Connors L, O’Keefe A, Rosenfield L, Kim H. Non-IgE-mediated food hypersensitivity. Allergy Asthma Clin Immunol. 2018;14 (Suppl 2): 56. doi: 10.1186/s13223-018-0285-2.

Martin VM, Virkud YV, Seay H, et al. Prospective assessment of pediatrician-diagnosed food protein-induced allergic proctocolitis by gross or occult blood. J Allergy Clin Immunol Pract 2020; 8 (5): 1692-1699.e1.

Ozen A, Gulcan EM, Ercan Saricoban H, Ozkan F, et al. Food protein-induced non-immunoglobulin E-mediated allergic colitis in infants and older children: what cytokines are involved? Int Arch Allergy Immunol 2015; 168 (1): 61-68.

Erdem SB, Nacaroglu HT, Karaman S, et al. Tolerance development in food protein induced allergic proctocolitis: single center experience. Allergol Immunopathol 2017; 45: 212-219.

Kumagai H, Maisawa S, Tanaka M, et al. Intestinal microbiota and secretory immunoglobulin A in feces of exclusively breast-fed infants with blood-streaked stools. Microbiol Immunol 2012; 56: 657-663.

Mennini A, Fiocchi AG, Cafarop A, Montesano M, et al. Food protein-induced allergic proctocolitis in infants: Literature review and proposal of a management protocol. World Allergy Organ J 2020; 13: 100-471. doi: 10.1016/j.waojou.2020.100471.

Baldassarre ME, Laforgia N, Fanelli M, et al. Lactobacillus GG improves recovery in infants with blood in the stools and presumptive allergic colitis compared with extensively hydrolyzed formula alone. J Pediatr 2010; 156: 397-401.

Liu SX, Li YH, Dai WK, et al. Fecal microbiota transplantation induces remission of infantile allergic colitis through gut microbiota re-establishment. World J Gastroenterol 2017; 23: 8570-8581.

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.

Derechos de autor 2023 Revista Alergia México