Food patch testing for irritable bowel syndrome - 09/02/13

Doi : 10.1016/j.jaad.2012.09.010

Michael B. Stierstorfer, MD ^a,^b,^⁎ , Christopher T. Sha, BS ^b, Marvin Sasson, MD ^a
^a East Penn Dermatology PC, North Wales, Pennsylvania
^b University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Reprint requests: Michael B. Stierstorfer, MD, East Penn Dermatology PC, 311 N Sumneytown Pike, Suite 1E, North Wales, PA 19454.

Abstract

Background

The traditional classification of irritable bowel syndrome (IBS) as a functional disorder has been challenged in recent years by evidence of ongoing low-grade gastrointestinal tract inflammation. Inflammation may alter gastrointestinal motility and thus be central to the pathogenesis of IBS. Many foods and food additives are known to cause allergic contact dermatitis. We hypothesize that allergenic foods and food additives may elicit a similar allergic reaction in the gastrointestinal tract, giving rise to symptoms suggestive of IBS.

Objective

We sought to determine whether skin patch testing to a panel of foods and food additives may identify food allergens that may be responsible for symptoms of IBS.

Methods

We performed skin patch testing to common allergenic foods and food additives on individuals with a history of or symptoms suggestive of IBS. We used patch test–guided avoidance diets to determine whether avoidance alleviates IBS symptoms.

Results

Thirty of the 51 study participants showed at least 1 doubtful or positive patch test result. Fourteen of the participants reported symptomatic improvement, ranging from slight to great, upon avoidance of the foods/food additives to which they reacted.

Limitations

Double-blind study design, inclusion of only patients with active IBS, larger sample size, more balanced gender distribution, testing of more foods/food additives, and longer duration of and more precise quantification of response to dietary avoidance are suggested for future studies.

Conclusion

Allergic contact enteritis to ingested foods, food additives, or both may contribute to IBS symptoms. Patch testing may be useful in identifying the causative foods.

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Key words : allergic contact dermatitis, allergic contact enteritis, food patch testing, functional bowel disorder, gastrointestinal dysmotility, irritable bowel syndrome, type-4 hypersensitivity

Plan

	Funding sources: None.
	Disclosure: Dr Stierstorfer has submitted a patent application to the US Patent and Trademark Office for food and food additive skin patch testing for irritable bowel syndrome and undifferentiated gastrointestinal disease. Mr Sha and Dr Sasson have no conflicts of interest to declare.