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Review
. 2025 Mar 30;72(1):35-61.
doi: 10.29262/ram.v72i1.1420.

[Non-IgE-mediated gastrointestinal food allergy. Updated literature review by the CMICA Food Allergy Committee]

[Article in Spanish]
Ileana María Madrigal-Beas  1 , Jonathan Higgins Payan-Díaz  2 , Alejandra Medina-Hernández  3 , María Gracia Belinda Guerrero-Núñez  4 , María de Los Angeles Juan-Pineda  5 , Daniela Rivero-Yeverino  6 , Blanca María Morfin-Maciel  7
Affiliations
Review

[Non-IgE-mediated gastrointestinal food allergy. Updated literature review by the CMICA Food Allergy Committee]

[Article in Spanish]
Ileana María Madrigal-Beas et al. Rev Alerg Mex. .

Abstract
in English, Spanish

Background: Non-IgE-mediated gastrointestinal food allergy includes adverse reactions to food mediated by the innate immune system and cellular immunity. It is characterized by subacute or chronic gastrointestinal symptoms after ingestion of a relevant food allergen, making diagnosis difficult.

Objective: To carry out an updated bibliographic review of non-IgE-mediated gastrointestinal food allergy, that summarizes incidence, pathophysiology, clinical manifestations, diagnostic tools and treatment.

Methodolgy: A search was conducted in the databases Medline, EMBASE, Scielo, Google Scholar and the Advanced Medicine Informatics Network (RIMA) using the keywords: non-IgE-mediated food allergy, allergic proctocolitis; cow's milk-induced anemia; food protein-induced enteropathy; food protein-induced enterocolitis syndrome; Celiac disease and Heiner syndrome. The search was limited to articles published in English and Spanish from January 2015 to May 2024.

Results: While progress has been made in the recognition of these diseases, the prevalence and pathophysiology remain uncertain. Involvement of the innate immune system and cellular immunity in gastrointestinal inflammation has been found, but further studies are needed to clarify the immunopathogenesis and associated biomarkers.

Conclusions: Non-IgE-mediated gastrointestinal food allergy account for an unknown proportion of food allergies. Since there are no biomarkers or non-invasive confirmatory tests, the diagnosis relies on clinical features and is confirmed when the symptoms improve with elimination of the offending food. Management includes avoidance of the causative food from the diet, supportive treatment in case of accidental exposure, and nutritional counseling.

Antecedentes: La alergia alimentaria no mediada por IgE incluye reacciones adversas a alimentos mediadas por el sistema inmune innato e inmunidad celular. Se caracteriza por síntomas gastrointestinales subagudos o crónicos luego de la ingestión de algún alérgeno alimentario relevante, lo que dificulta el diagnóstico.

Objetivo: Revisar la bibliografía actualizada de los cuadros gastrointestinales por alergia alimentaria no mediada por IgE, que resuma la incidencia, fisiopatología, cuadro clínico, diagnóstico y tratamiento.

Metodología: Se realizó una búsqueda en las bases de datos Medline, EMBASE, Scielo, Google Académico y la red informática de medicina avanzada (RIMA) empleando las palabras clave: alergia alimentaria no mediada por IgE, proctocolitis alérgica; anemia inducida por leche de vaca; enteropatía inducida por proteínas alimentarias; síndrome de enterocolitis inducida por proteínas alimentarias; enfermedad celiaca y síndrome de Heiner. La búsqueda se limitó a artículos publicados en idioma inglés y español, de enero de 2015 a mayo de 2024.

Resultados: Aún con los avances en el reconocimiento de la alergia alimentaria no mediada por IgE, permanece incierta su prevalencia y fisiopatología. El sistema inmune innato y la inmunidad celular están implicados en la inflamación gastrointestinal; no obstante, se requieren estudios adicionales para esclarecer la inmunopatogénesis y biomarcadores asociados.

Conclusiones: Las alergia alimentaria no mediada por IgE representan una proporción desconocida de las alergias alimentarias. Puesto que no existen biomarcadores ni pruebas diagnóstica no invasivas, el tratamiento se establece por la sospecha clínica y se corrobora cuando los síntomas disminuyen, después de eliminar el alimento causante de la alergia entre 4 y 8 semanas. El tratamiento incluye la supresión en la dieta del alimento implicado, apoyo en caso de exposición accidental y asesoramiento nutricional.

Keywords: Allergic proctocolitis; Celiac disease; Cow’s milk-induced anemia; Food protein-induced enterocolitis syndrome; Food protein-induced enteropathy; Heiner syndrome; Non-IgE-mediated food allergy.

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Conflict of interest statement

No existen conflictos de interés para ninguno de los autores.

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References

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