# Allergic Disease Linked to Irritable Bowel Syndrome



## Jeffrey Roberts

*Allergic Disease Linked to Irritable Bowel Syndrome*In a study of 125 adults, investigators at Rush University Medical Center, Chicago, found the likelihood of Irritable Bowel Syndrome (IBS) was significantly higher in patients with seasonal allergic rhinitis (2.67 times), patients with allergic eczema (3.85 times), and patients with depression (2.56 times), suggesting a link between atopic disorders and IBS. Newswise - Adults with allergy symptoms report a high incidence of Irritable Bowel Syndrome (IBS), suggesting a link between atopic disorders and IBS according to a study published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).In a study of 125 adults, Mary C. Tobin, M.D, Department of Immunology/Microbiology at Rush University Medical Center, Chicago, and colleagues found the likelihood of IBS was significantly higher in patients with seasonal allergic rhinitis (2.67 times), patients with allergic eczema (3.85 times), and patients with depression (2.56 times). Irritable Bowel Syndrome, affecting 15 percent of the general population, is a cluster of symptoms including abdominal pain for 12 weeks within the past year, change in stool consistency or frequency, and relief of abdominal pain with defecation. Various findings suggest indirectly that allergen exposure may lead to IBS symptoms in some patients, but the frequency has not been studied."The reported presence of allergic dermatitis was highly correlated to the presence of IBS in our population," investigators noted. "In atopic disease, allergic dermatitis is the first step of the 'atopic march.' In early childhood, AE (allergic eczema) is frequently associated with gastrointestinal dysfunction and food allergy. A clinical history of AE may be a useful marker for patients with gut hypersensitivity and atopic IBS."Asthma and Irritable Bowel Syndrome was reported by 12 of 41 patients (29 percent), which is similar to findings in a previous report. Authors propose that "this subgroup of IBS (atopic IBS) be considered separately from patients with IBS without atopic symptoms, because they may have distinct pathophysiologic features and may benefit from specific therapeutic interventions."Patient information on allergic diseases is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org.An allergist-immunologist is a physician who specializes in the diagnosis and treatment of asthma and other allergic diseases. The allergist is specially trained to identify the allergic and non-allergic factors that trigger asthma and other allergic diseases. Allergists help people treat or prevent their allergy problems. After earning a medical degree, the allergist-immunologist completes a three-year residency training program in either internal medicine or pediatrics. Next the allergist completes two or three more years of study in the field of allergy-immunology in order to prepare for certification by the American Board of Allergy and Immunology.The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.Citation: Tobin MC, et al. Atopic irritable bowel syndrome: a novel subgroup of irritable bowel syndrome with allergic manifestations. Ann Allergy Asthma Immunol 2008;100:49-53.Annals of Allergy, Asthma & Immunology is online at http://www.annallergy.org.--------------------------------------------------------------------------------© 2008 Newswise. All Rights Reserved.


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## Jeffrey Roberts

*Atopic irritable bowel syndrome: A novel subgroup of irritable bowel syndrome with allergic manifestations*Source: Annals of Allergy, Asthma and Immunology, Jan 2008 by Mary C Tobin, et al.01-31-2008 Background: Mast cells have a primary role in atopy. Mast cells may play a unique role in a subgroup of patients with irritable bowel syndrome (IBS). This observation suggests a link between atopic disorders and IBS. Objective: To determine whether there is an association between atopic disorders and IBS. Methods: We undertook a prospective study using structured questionnaires. We administered questionnaires to 125 consecutive patients seen in the following clinics from July 1 through October 31, 2001: allergy/immunology (AI) (n = 39), gastroenterology (n = 36), and general medicine (n = 50). The survey included questions detailing gastrointestinal and allergic symptoms. Diagnosis of IBS was based on Rome II criteria. Diagnosis of atopy was based on clinical parameters. Results: The AI clinic reported a significantly (P = .015) higher rate of IBS than the general medicine clinic. The IBS incidence reported in the AI clinic was similar to that reported in the gastroenterology clinic. The likelihood of IBS was significantly higher in patients with seasonal allergic rhinitis (2.67 times; 95% confidence interval [CI], 1.10-6.49; P = .03), patients with allergic eczema (3.85 times; 95% CI, 1.72-8.60; P = .001), and patients with depression (2.56 times; 95% CI, 1.05-6.14; P = .04). Patients reporting atopic symptoms (seasonal allergic rhinitis, allergic eczema, and asthma) were 3.20 times (95% CI, 1.20-8.50) (P = .02) more likely to fulfill the criteria for IBS. Conclusions: Adults with atopic symptoms report a high incidence of IBS, suggesting a link between atopy and IBS. We proposed a subgroup of patients with IBS (atopic IBS) who have typical IBS symptoms in association with atopic manifestations. Identifying atopic vs nonatopic IBS may help in identifying the underlying pathophysiologic mechanisms and therapeutic options. Source: Annals of Allergy, Asthma and Immunology. January 2008, vol. 100, no. 1, pp. 49 - 53. by tobin MC, Moparty B, Farhadi A, DeMeo MT, Gansal PJ, Keshavarzian A. Rush University Medical Center, Chicago, USA.


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## eric

Before you posted this second one I was going to post I bet the mast cells are involved.FYI"You have two brains: one in your head and another in your gut. Dr. Jackie D. Wood is a renowned physiologist at The Ohio State University. He calls the second brain, "the-little-brain-in-the-gut." This enteric nervous system is part of the autonomic nervous system and contains over one hundred million neurons, which is as many as are in the spinal cord. This complex network of nerves lines the walls of the digestive tract form the esophagus all the way down to the colon. This little brain in the gut is connected to the big brain by the vagus nerves, bundles of nerve fibers running from the GI tract to the head. All neurotransmitters, such as serotonin that are found in the brain are also present in the gut.Dr Wood has discovered that this little-brain-in-the-gut has programs that are designed for our protection and which are very much like computer programs. They respond to perceived threats in the same way that the limbic system or the emotional brain does. So the threat of a gastrointestinal infection can activate the program that increases gut contractions in order to get rid of the infection. The symptoms are abdominal cramping and diarrhea. Dr. Wood has determined that a type of cell found in the body and the gut, called the mast cell, is a key to understanding the connection of the big brain in the head with the little-brain-in-the-gut. Mast cells are involved in defense of the body. In response to certain threats or triggers, such as pollen or infection, mast cells release chemicals, such as histamine, that help to fight off the invader. Histamine is one of the chemicals that causes the symptoms of an allergy or a cold. When an infection of the gut occurs, such as food poisoning or gastroenteritis, the mast cells of the gut release histamine. The little-brain-in-the-gut interprets the mast cell signal of histamine release as a threat and calls up a protective program designed to remove the threat â€" at the expense of symptoms: abdominal pain and diarrhea. The brain to mast cell connection has a direct clinical relevance for irritable bowel syndrome and other functional gastrointestinal syndromes. It implies a mechanism for linking allostasis and the good stress response to irritable states (e.g., abdominal pain and diarrhea) of the gut. Mast cells can be activated to release histamine in response to perceived psychological stress, whether the stressor or trigger is consciously perceived or not. So the end result is the same as if an infection activated the program in the-little-brain-in-the-gut: abdominal pain and diarrhea."http://www.parkviewpub.com/nuggets/n5.html


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## gilly07

Hi Jeffrey and Eric,this is very interesting.Ive always wondered whether there was a connection.Did the articles suggest any treatments? Claratyne and claramax at doses for rhinitis did not help the IBS.Would there be anything worth trying to suppress the masts cell response?Thanks for the research Gilly


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## gilly07

OK I found another study 2006 on pubmed and they also treated the patients in the study with zyrtec 10mg per day and ranitidine 300mg twice per day.The study is mastocytic enterocolitis:increased mucosal mast cells in chronic intractable diarrhea.I think it seems worth a try, but I am trying to see whether histamine consumption in foods would be related to this.Gilly


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## overitnow

Curious. My IBS erupted in 1988. Bleeding eczema on my hands started in 1991. The bowels and GERD trace pretty clearly to cigarettes, diet, and resulting cardio problems. The eczema was an allergy to chlorine and chemicals on lotto tickets (I sold them for a living) and money. I was in food service for extended periods in my working life, and late in that could bring on eczemic hands through exposure to various sanitizers at work. As well, there is lead used on the "scratch" part of instant tickets, and I certainly was exposed to huge quantities of that, as well, and since digestive and bowel disorders stem from ingestion of that, that may well have also been a contributing factor. My final job was in account receivable. We hand stuffed the monthly statements that were printed on computers. I had to wear gloves during that ooperation or my hands would break out. I know you have written lots about mast cells and I have generally not paid much attention to those discussions, but I wonder if the wide array of chemicals in cig smoke as well as at my workplaces could all have cocktailed together to create those problems in me.Mark


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## arianis227

Does the zyrtec work for ibs that is both types? I have been looking for an answer a long time.


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## TexasMom

Pro-algesic and pro-inflammatory mediators (cytokines for example) have been shown to provoke many of the symptoms of IBS and migraine patients: ----------------Recent studies have overthrown the dogma that Irritable Bowel Syndromeis characterized by no abnormality of structure by demonstrating low-grade lymphocytic infiltration in the gut mucosa, increased permeability and increases in other inflammatory components including enterochromaffin and mast cells. Furthermore, increased inflammatory cytokines in both mucosa and blood have been demonstrated in Irritable Bowel Syndrome&#8230;Post-infectious irritable bowel syndrome.Spiller R, Campbell E.Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK. Curr Opin Gastroenterol. 2006 Jan;22(1):13-7. ---------------Cytokines (and other inflammatory mediators) have been found to be elevated in IBS patients: "IBS patients showed significantly (P < .017) higher baseline TNF-alpha, IL-1beta, IL-6, and LPS-induced IL-6 levels compared with healthy controls. Analyzing IBS subgroups, all cytokine levels were significantly (P < .05) higherin diarrhea-predominant IBS (D-IBS) patients, whereas constipation-predominantIBS patients showed increased LPS-induced IL-1beta levels compared with healthy controls. Baseline TNF-alpha and LPS-induced TNF-alpha and IL-6 levels weresignificantly higher in patients reporting more than 3 bowel movements per day, urgency, watery stools, and pain associated with diarrhea."Immune Activation in Patients with Irritable Bowel Syndrome. Liebgrets T, Adams B, et alDepartment of Gastroenterology and Hepatology, University of Adelaide, Royal Adelaide Hospital, South Australia; Nerve-Gut Research Laboratory, Hanson Institute, Adelaide, SA, Australia.Gastroenterology. 2007 Mar;132(3):913-20. Epub 2007 Jan 26How do you easily measure the release of mediators? Dr. Mark Pasula, PhD in immunology has developed a test called the Mediator Release Test (MRT). It is not practical to measure single mediators, and since so many mediators are implicated in IBS, a method that detects the "end result" or end-point reaction works very well to determine what food and chemical triggers are provoking that response. Then, a patient oligoantigenic diet is formulated based on their specific blood test results. When a person eats only their non-reactive foods as indicated on their test results , they quit reacting, usually within days. ----------"Use of the LEAP-Mediator Release Test to Identify Non-IgE Mediated Immunologic Food Reactions That Trigger Diarrhea Predominant IBS Symptoms Results in Marked Improvement of Symptoms Through Use of an Elimination Diet"American College of Gastroenterology Annual Scientific Meeting Meeting, November, 2004; Williams, Fred H., M.D., Department of Gastroenterology, St. John's Mercy Medical Center, St. Louis, Missouri ------------"Many clinicians have long suspected that symptoms of IBS are somehow related to diet. In fact, research conducted over many years in Europe suggests that many cases of IBS are, in fact, the result of inflammatory reactions to specific foods or ingredients. Further, some cases of migraine appear to be linked to food intolerances as well. Now, a company in Florida has developed a Disease Management Program [LEAP®] that can pinpoint specific cases of food intolerance and create an individualized Program for eliminating symptoms." Alternative Approach to IBS and Migraine is Winning Over Providers. Disease Management Advisor. 2004 Jan;10(1):6-10, 1 ----------------I have placed over 400 IBS, migraine and fibromyalgia patients on oligoantigenic diets based on the results of mediator release testing........ I have only had 3 (2 migraine and one diarrhea patient) who did not respond. Everyone else (Mostly IBS diarrhea/cyclic and/or migraine) improved by a minimum of 50% the first week, but usually 80%....... if they aren't eating anything reactive, they quit reacting! They are tested for 123 foods and 27 chemicals (natural chemicals like solanine, tyramine, salicylates, as well as artificial chemicals like dyes, ibuprofen, MSG etc). The person then eats what they did not react to for one month. Easy and works very very quickly. Many doctors all over the country are incorporating this test into their practice. Susan


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## eric

Gilly, I have been away for a month, but will post more, but this is from the m,ain forum disscusion here.Your posting some older work and they are much farther ahead now and some of what your posting again has nothing to do with IBS.We also have no way to know what people coming to see you were diagnosed with the rome critira, because I am sure some people with food issues come to see you.your also talking about neurogenic inflammation in IBS, WITHOUT EVEN REALIZING IT."Eric, I am not an immunologist, and I agree that foods are not the original cause of IBS and I'm sorry if I implied that. It is the loss of oral tolerance to foods/chemicals that triggers the immune response that provoke the release of pro-inflammatory and pro-algesic mediators. "This may sound good but there is no evdidence for this in IBS research other then some foods can trigger the mast cells, but you are not posting about that with the "Full Thickness Biopsy of the Jejunum Reveals Inflammation and Enteric Neuropathy in Irritable Bowel Syndrome Gastroenterology study."You would also need to follow the patients for a year, because there is a very high placebo responce rate in IBS. This is recognized with all researcher studying IBS and clinical trials. We also hear this kind of thing alot on the bb here in the past from food testing people, but there never any clinical trials ort actual research howing anything like the results mentioned here.IBS is already a brain gut axis disorder. It is a functional disorder "how the body works" and they have found STRUCTURAL CELL abnormalities in IBS.Allergies: Dubious Diagnosis and Treatment "The LEAP Program, in which the Mediator Release Test (MRT) is used to identify "delayed food allergies" and treatment involves dietary manipulation and possibly supplements and/or herbs. "http://www.quackwatch.org/01QuackeryRelate...lergytests.htmlNeuromuscular Dysfunction and IBS: Clinical Implications"Several investigators have demonstrated increased levels of inflammatory cells and mediators in a subset of IBS patients,[4,5] but these data have been inconsistent"http://www.medscape.com/viewarticle/548600These are experts in immunology, food allergy and IBS and they don't agree with what your saying here.FYI"You have two brains: one in your head and another in your gut. Dr. Jackie D. Wood is a renowned physiologist at The Ohio State University. He calls the second brain, "the-little-brain-in-the-gut." This enteric nervous system is part of the autonomic nervous system and contains over one hundred million neurons, which is as many as are in the spinal cord. This complex network of nerves lines the walls of the digestive tract form the esophagus all the way down to the colon. This little brain in the gut is connected to the big brain by the vagus nerves, bundles of nerve fibers running from the GI tract to the head. All neurotransmitters, such as serotonin that are found in the brain are also present in the gut.Dr Wood has discovered that this little-brain-in-the-gut has programs that are designed for our protection and which are very much like computer programs. They respond to perceived threats in the same way that the limbic system or the emotional brain does. So the threat of a gastrointestinal infection can activate the program that increases gut contractions in order to get rid of the infection. The symptoms are abdominal cramping and diarrhea. Dr. Wood has determined that a type of cell found in the body and the gut, called the mast cell, is a key to understanding the connection of the big brain in the head with the little-brain-in-the-gut. Mast cells are involved in defense of the body. In response to certain threats or triggers, such as pollen or infection, mast cells release chemicals, such as histamine, that help to fight off the invader. Histamine is one of the chemicals that causes the symptoms of an allergy or a cold. When an infection of the gut occurs, such as food poisoning or gastroenteritis, the mast cells of the gut release histamine. The little-brain-in-the-gut interprets the mast cell signal of histamine release as a threat and calls up a protective program designed to remove the threat â€" at the expense of symptoms: abdominal pain and diarrhea. The brain to mast cell connection has a direct clinical relevance for irritable bowel syndrome and other functional gastrointestinal syndromes. It implies a mechanism for linking allostasis and the good stress response to irritable states (e.g., abdominal pain and diarrhea) of the gut. Mast cells can be activated to release histamine in response to perceived psychological stress, whether the stressor or trigger is consciously perceived or not. So the end result is the same as if an infection activated the program in the-little-brain-in-the-gut: abdominal pain and diarrhea."http://www.parkviewpub.com/nuggets/n5.html Dr Wood's comments for me"Dr. Jack Wood, a renowned physiologist at The Ohio State University calls the ENS the little-brain-in-the-gut. "Dear Shawn:Sorry for the delayed reply to your question. I generally agree with Dr. Drosssman's response. A subgroup of individuals when they become sensitized to specific molecules in certain foods respond to ingestion of the molecules with symptoms of cramping abdominal pain, fecal urgency and explosive watery diarrhea. These are also the primary symptoms of diarrhea-predominant IBS. Enteric mast cells, by mechanisms we don't understand, become sensitized to the food molecule and respond to its presence by releasing a signal to the brain-in-the-gut (ENS) which is interpreted as a threat. The ENS responds by running a program which organizes secretion and motility into a behavior pattern of the bowel, which rapidly clears the threat from the lumen. Because to be effective secretion occurs in large volumes and the contractions that accomplish rapid propulsion are strong, running of the program has the side effects of diarrhea and cramping pain. Big brain input to mast cells during stress activates the mast cells to evoke the symptoms resulting from exposure of the mast cells to sensitizing food antigens. Aside from food allergens and mast cells, certain chemicals such as those in hot peppers, stimulate sensory nerves in the ENS and we are beginning to understand how this can also lead to food-related symptoms that might mimic or exacerbate IBS.Hope this helps,Jackie (Jack) D. Wood " Mast cell and cellularity of the colonic mucosa correlated with fatigue and depression in the irritable bowel syndrome."CONCLUSIONS: Elevated MCs counts are a key feature of the low grade inflammatory infiltrate in the caecal mucosa of IBS. Fatigue and depression are associated with mucosal cell counts, in particular MCs suggesting that psychological factors are associated to the low-grade inflammatory infiltrate in IBS."http://www.ibsgroup.org/forums/index.php?showtopic=93117Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood."AUTHORS' CONCLUSIONS: There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP."http://www.ibsgroup.org/forums/index.php?showtopic=93790I know you could not have gone through all the information above yet, but they are not showing what your saying about foods and IBS. There have been people here before you posting almost exactly the same info you are now years ago? They are five to six years however more advanced then they were then on IBS research. There are also some major issues with Leap testing itself as well as the below."The Australasian Society of Clinical Immunology and Allergy has issued this paper on Allergy testing and treatments."Unorthodox Techniques for the Diagnosis and Treatment of Allergy, Asthma and Immune Disorders "Inappropriate use of Conventional Testing"Comment: Inappropriate used may be divided into three areas. (1) Inappropriate patient selection. As with any diagnostic test, use in patients where there is no evidence that food allergy plays a role in pathogenesis increases the likelihood of irrelevant false positive results. Use of food allergy testing in patients with inhalant allergy, for example, may lead to inappropriate and unnecessary dietary restrictions, with particular nutritional implications in children. (2) Misinterpretation of results. Low levels of food-reactive IgE are found in some healthy individuals without clinical reactivity. Challenge studies have shown a correlation between allergen-specific IgE and then likelihood of reactivity to some (such as cows milk, egg and peanut) but not all foods. In the absence of a history of clinical reactivity, low levels of allergen-specific IgE are usually of little diagnostic significance. (3) Inappropriate data presentation. Presentation of data as "raw counts" has no scientific or clinical rationale, has not been shown to correlate with clinical reactivity and renders results more liable to misinterpretation. "http://www.allergy.org.au/pospapers/unorthodox.htmThe mast cells are also not the only problem, just a part of the problem. There is a lot already know about them and a lot more being done on them now, they are connected to the brain's immune responce and gut immune responce and also to the bodies stress system to protect the entire organism from ANY threats. Mast cells can be degranulated by foods, stress, hot and cold, and certain medications among many other reasons.


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