Multifaced allergies: gastrointestinal manifestations of food allergy in children. Issues of diagnosis and management
The manifestations of food allergies are varied. They affect not only the skin, which pediatricians are traditionally accustomed to, but also the gastrointestinal and respiratory tracts. A typical scenario for the development of gastrointestinal manifestations of food allergy in infants fully reproduces that observed in functional and organic lesions of the gastrointestinal tract. Infantile colic may be the first manifestation of an atopic disease. Therefore, the differential diagnosis of gastrointestinal allergy for pediatricians is important. There is both hyper- and underdiagnosis of the gastrointestinal form of allergy. This is primarily due to the fact that the immunopathological mechanism of gastrointestinal allergy is diverse and includes both IgE-mediated and non-IgE-mediated variants. At the same time, the clinical symptoms almost resemble manifestations of the functional pathology of the gastrointestinal tract and there are no elevated IgE levels. The main method of differential diagnosis is only the elimination of the food product and, conversely, the appearance of symptoms after its return (provocation). Therefore, it is necessary that pediatricians have a clear understanding that the basis of diagnosis is not only clinical symptoms, but the response to diet therapy.