5Eosinophils and allergic diseases of the gastrointestinal tract
Section snippets
Regulation of intestinal immune responses
The intestinal mucosa has to meet the challenge of protecting the host against possibly harmful nutrients, microbes and toxins on the one hand, while on the other hand ensuring the uptake of nutrients and antigens indispensable for life.5 To do this, the gastrointestinal barrier is equipped with an innate immune system and other non-specific defence systems, including gastric acid, mucus and bicarbonate secretion, as well as an intact epithelial layer forming tight junctions, peristaltic
Association between eosinophils and allergy
Eosinophils have been proposed as major contributors to allergic inflammation, because they are typically found in increased numbers at sites of allergic inflammation, and they are activated for mediator release in the course of type-I allergic reactions. The factors responsible for eosinophil recruitment are mostly identified, and include interleukins (IL-5, and to a lesser extent IL-3 and GM-CSF) and chemokines (e.g. eotaxin and RANTES; for details see Chapter 2 of the issue). The mechanisms
Clinical presentation of allergic diseases in the gastrointestinal tract
Allergic symptoms vary from marginal impairments to life-threatening shock reactions. Major targets of food allergy are the skin, the respiratory tract and the gastrointestinal tract (Table 3), either alone or in combination.38, 39 Possibly the gastrointestinal tract is the primary ‘allergy organ’, since it forms the largest barrier of the host to the environment (∼400 qm, compared to skin, 2 qm), it is exposed to huge amounts of antigen (40 g food proteins per day, of which 2% are not hydrolysed
Eosinophilic oesophagitis
The presence of eosinophils in the oesophagus indicates an abnormal situation, since the oesophagus is usually devoid of eosinophils.60 Such conditions typically occur in association with allergic disease, or remain idiopathic, but finally they cause chronic inflammation independent of the aetiology of disease.
Two different subtypes of eosinophil-associated oesophageal disorders are differentiated: primary and secondary. Atopic, non-atopic, and familial forms belong to the primary subtype,
Diagnostic means for confirming allergic eosinophilic diseases
The principle of the diagnostic approach is to combine the diagnostic means for EGIDs, as described in Chapters 3 and 4, with those for allergic diseases, while excluding other gastrointestinal diseases such as food intolerances, IBD, IBS, infections, and tumour diseases.
The first step for the evaluation of a possible allergic EGID is obtaining a detailed history of atopy and ARF.4 Extraintestinal manifestations of allergy such as hay fever, asthma, an atopic dermatitis, high total IgE levels
Dietetic management
The basis of any successful treatment of confirmed food allergy is an elimination diet, regardless of whether eosinophils are involved or not. This requires not only that the diagnosis be confirmed but also that the relevant offending food components be identified. Both IgE-dependent and IgE-independent mechanisms can be involved. Food elimination based solely on SPT have not been efficacious, but exclusion of food identified by a combination of SPT and patch testing has shown good success
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Induction of IL-13 production and upregulated expression of protease activated receptor-1 by RANTES in a mast cell line
2011, CytokineCitation Excerpt :Although a cell line, rather than primary mast cells was used for the study, it is found for the first time that RANTES can selectively provoke IL-13, but not IL-12 release from mast cells. Since IL-13 is a classic Th2 cytokine, which has been recognized as a crucial cytokine in regulation of allergic inflammation [28], and RANTES has been identified as one of the major regulators of eosinophil chemotaxis and activation [29] and is responsible for edema formation and histamine release caused by mast cell degranulation and eosinophil influx in allergic paw edema and pleurisy [30], our finding may provide further evidence that RANTES plays a proinflammatory role in allergic reactions. Little is known of influence of RANTES on cytokine release from mast cells.
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