Gastrointestinal allergies

K9. Kunstadter, R. H., and Schultz, A., Gastrointestinal allergy and the coeliac syndrome, with particular reference to allergy of cows milk. Ann. Allergy 11, 426-434 (1953). 

Chatila TA Extraintestinal manifestations of gastrointestinal allergy effector and regulatory T cells in the balance. Clin Exp Allergy 2007 37 1417-1418. 

Cromolyn, nedocromil Alters function of delayed chloride channels inhibits inflammatory cell activation Prevents acute bronchospasm Asthma (other routes used for ocular, nasal, and gastrointestinal allergy) Aerosol t duration 6-8 h t Toxicity. Cough not absorbed so other toxicities are minimal... 

Immediate-onset reactions Late-onset reactions IgE-mediated gastrointestinal reactions Oral allergy syndrome Immediate gastrointestinal allergy IgE-mediated respiratory reactions... 

Parvalbumin was found to be a major fish allergen in approximately 70% of fish allergies, mediated by parvalbumin IgE antibodies, leading to respiratory and gastrointestinal symptoms. Parvalbumin also became of interest because of its potential use in gene therapy to correct cardiomyopathy. 

Penicillins should be used cautiously in patients witii renal disease, pregnancy (Pregnancy Category C), lactation (may cause diarrhea or candidiasis in die infant), and in tiiose witii a history of allergies. Any indication of sensitivity is reason for caution. The drug is also used witii caution in patients witii asthma, renal disease, bleeding disorders, and gastrointestinal disease. 

Before administering an NSAID, it is important for the nurse to determine if the patient has any history of allergy to aspirin or any otiier NSAID. The nurse determines if die patient has a history of gastrointestinal bleeding, hypertension, peptic ulceration, or impaired hepatic or renal function. If so, the nurse notifies the primary health care provider before administering an NSAID. 

The response varies, depending on the individual and the allergen. The worst case is that anaphylactic shock arises when gastrointestinal, cutaneous and respiratory symptoms occur in conjunction with a dramatic fall in blood pressure and cardiovascular complications. Death can occur within minutes of anaphylactic shock. Table 4 lists the other symptoms of IgE allergy. 

These are called delayed hypersensitivity reactions since they normally occur 6-24 hours after exposure. A cell-mediated allergy involves the interaction of food allergens with sensitised lymphocytes, which usually occurs in the gastrointestinal tract. The sensitised lymphocytes produce lymphokines and the generation of cytotoxic T lymphocytes. These latter cells destroy other intestinal cells, including the epithelial cells that are critical for absorption. 

Many different symptoms can occur during IgE-mediated food allergies including cutaneous, gastrointestinal, respiratory, and sometimes cardiovascular symptoms (Table 4.3). Reactions can sometimes be fairly mild, but severe and life-threatening reactions involving symptoms such as lar)mgeal edema, asthma, and anaphylactic shock can occur on occasion. 

Major limitations of the use of allopurinol are allergy, hypersensitivity syndromes, hepatotoxicity, bone marrow suppression, nonspecific central nervous system and gastrointestinal side effects. Skin rash occurs in 2% and Steven-Johnson syndrome, although rare, may occur. The latter can cause life-threatening major organ system failure. 

The same molecules used to treat allergies and cold symptoms have many other uses. Antihistamines are particularly effective as antiemetics in suppressing nausea associated with gastrointestinal illnesses. They can also be used to treat the symptoms of motion sickness or even vestibular disturbances (vertigo). Because of their ability to induce sedation, antihistamines are widely used in over-the-counter sleep aids. 

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