Artikel
Gastrointestinally mediated food allergy (GMA) causing Spondylarthropathy-like disease
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Autoren
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Stephanie Finzel
- Universitätsklinikum Freiburg, Medizinische Klinik 6, Rheumatologie und klinische Immunologie, Freiburg
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Ralf Rieker
- Pathologisches Institut, Pathologisches Institut, Erlangen
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Francesco Vitali
- Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Erlangen
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Axel Braun
- Department of Medicine II, Gastroenterology, Interventional Endoscopy, Hemato-Oncology, Diabetes- and metabolic diseases, Waldkrankenhaus St. Marien Erlangen, Gastroenterology, Interventional Endoscopy, Hemato-Oncology, Diabetes- and metabolic diseases, Erlangen
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Jürgen Kressel
- Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Erlangen
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Markus Neurath
- Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Erlangen
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Hanns-Wolf Baenkler
- Department of Internal Medicine III, Rheumatology and Clinical Immunology, Erlangen
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Martin Raithel
- Department of Medicine I, Gastroenterology, University of Erlangen-Nuremberg, Erlangen, Germany Department of Medicine II, Gastroenterology, Interventional Endoscopy, Hemato-Oncology, Diabetes- and metabolic diseases, Waldkrankenhaus St. Marien Erlangen, Gastroenterology, Interventional Endoscopy, Hemato-Oncology, Diabetes- and metabolic diseases, Erlangen
| Veröffentlicht: | 29. August 2016 |
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Gliederung
Text
Background: Gastrointestinally-mediated food allergy (GMA) may cause various intestinal and extraintestinal symptoms and may be involved in rare cases of non-erosive oligoarthritis.
Methods: A 56-year-old woman earlier diagnosed with seronegative spondyloarthropathy presented in our Outpatient Clinics because of a connection between food ingestion and exacerbation of arthritis; therapeutic fasting improved her oligoarthritis.
Results: Blood analyses with C-reactive protein, blood eosinophils, histamine, serum-ECP, tryptase, TNF-alpha, total and food-specific IgE in serum were unspecific.
Endoscopically-guided segmental gut lavage during ileo-colonoscopy revealed plasmacellular infiltrates and intestinal eosinophilia in the terminal ileum suspicious of allergic enteritis.
Food allergen-specific IgE-analysis of lavage fluid showed significant polyvalent intestinal IgE sensitization (>0.35kU/mg protein) in terminal ileum towards wheat, rye, egg, soy bean, pork, beef, and nuts.
After two repeated food challenges with wheat, rye and pork an arthritic relapse occurred after 48 hours. Thus, a seronegative local IgE-mediated GMA (type I) was diagnosed. A subsequent elimination diet of these intestinal IgE-positive allergens led to long-lasting remission of her arthritis.
Conclusion: Especially seronegative rheumatoid arthritis and seronegative spondyloarthropathy should be critically examined for food related complaints before initializing immunosuppressive treatment. In some patients detection of food allergen-specific IgE in gut may unravel hidden local food allergy, triggering nutrition-induced arthralgia and arthritis.
