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LEAP - Where Disease Management Begins with Disease, not Data

Non-Allergic Food Intolerance Reactions In IBS 
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Several well-controlled studies have demonstrated the involvement of non-IgE mediated immunologic reactions in patients that present with diarrheic predominant or “cyclic” IBS symptoms. These reactions involve release of proinflammatory and proalgesic mediators from various immunocytes and platelets. However these abnormal immune reactions are wholly different than typical IgE mediated allergic reactions both in terms of underlying pathways and clinical presentation. The defining characteristics of IBS related Food Intolerance are listed in the adjacent table.
Page 1051 of the 2002 Merck Manual or online Merck Manual at: http://www.merck.com/pubs/mmanual/ section12/chapter148/148b.htm

"Recently Food Intolerance was found to be responsible for symptoms of some patients* with the IRRITABLE BOWEL SYNDROME, confirmed by double-blind food challenge. An increase in rectal prostaglandin levels was noted when a reaction occurred.

Preliminary information suggests the same phenomenon may take place in patients with chronic ulcerative colitis.”


*The “some patients” means those with a diarrheic component. The same mechanism is not suspected in constipation predominant IBS
Recently Food Intolerance was found to be responsible for symptoms of some patients* with the IRRITABLE BOWEL SYNDROME, confirmed by double-blind food challenge. An increase in rectal prostaglandin levels was noted when a reaction occurred.
Factors That Make Non-Allergic Food Intolerance a Clinical Challenge In Management Of IBS:
Any foods or additives can be Reactive

Specific offending food/food additives vary widely from patient to patient
It is common to have multiple reactive foods and additives

Reactive foods can be dosage dependent (provoking dose in cell-mediated reactions can vary widely)
In contrast to typical allergic reactions, symptom onset can be delayed many hours after ingestion
Provoking foods/additives generate global symptoms (extra-intestinal) as well
Prescribed Diet/Symptom Diaries frequently show no discernable pattern, leading the patient and physician to the false conclusion that neither foods nor additives are playing a role in the patient’s symptoms
While Elimination & Challenge Diets can be effective at isolating food intolerances, they are tedious, time consuming, nutritionally unbalanced, and are poorly complied with. They are at best impractical and at worst unhealthy
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