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World J Gastroenterol. Aug 28, 2014; 20(32): 11023-11032
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11023
Non-pulmonary allergic diseases and inflammatory bowel disease: A qualitative review
David S Kotlyar, Mili Shum, Jennifer Hsieh, Wojciech Blonski, David A Greenwald
David S Kotlyar, Medical Oncology Service, NIH National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, United States
Mili Shum, Department of Medicine, New York/Presbyterian Medical Center, New York, NY 10021, United States
Jennifer Hsieh, Division of Gastroenterology, Department of Medicine, SUNY Stony Brook, Stony Brook, NY 11790, United States
Wojciech Blonski, Department of Medicine, SUNY Upstate, Binghamton Campus, Binghamton, NY 13902, United States
Wojciech Blonski, Medical University, 53-111 Wroclaw, Poland
David A Greenwald, Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Author contributions: Kotlyar DS wrote majority of text, edited entirety of text, originated idea for paper, searched and obtained most references, wrote original outline of paper; Shum M wrote sections on atopy and on nutrition; Hsieh J wrote on probiotics; Blonski W helped to write section on biomarkers; Greenwald DA helped to formulate plan for paper; Shum M, Hsieh J, Blonski W and Greenwald DA assisted in editing entire paper; all the authors approved final version of paper to be published.
Supported by NIH Intramural Program to Kotlyar DS; NCI Fellowship Program, NIH
Correspondence to: David A Greenwald, MD, Professor, Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 625 Ullman Building, 1300 Morris Park Avenue, Bronx, NY 10461, United States. dgreenwa@montefiore.org
Telephone: +1-718-4302098 Fax: +1-718-4302098
Received: September 29, 2013
Revised: February 16, 2014
Accepted: April 14, 2014
Published online: August 28, 2014

While the etiological underpinnings of inflammatory bowel disease (IBD) are highly complex, it has been noted that both clinical and pathophysiological similarities exist between IBD and both asthma and non-pulmonary allergic phenomena. In this review, several key points on common biomarkers, pathophysiology, clinical manifestations and nutritional and probiotic interventions for both IBD and non-pulmonary allergic diseases are discussed. Histamine and mast cell activity show common behaviors in both IBD and in certain allergic disorders. IgE also represents a key immunoglobulin involved in both IBD and in certain allergic pathologies, though these links require further study. Probiotics remain a critically important intervention for both IBD subtypes as well as multiple allergic phenomena. Linked clinical phenomena, especially sinonasal disease and IBD, are discussed. In addition, nutritional interventions remain an underutilized and promising therapy for modification of both allergic disorders and IBD. Recommending new mothers breastfeed their infants, and increasing the duration of breastfeeding may also help prevent both IBD and allergic diseases, but requires more investigation. While much remains to be discovered, it is clear that non-pulmonary allergic phenomena are connected to IBD in a myriad number of ways and that the discovery of common immunological pathways may usher in an era of vastly improved treatments for patients.

Keywords: Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Food intolerance, Food allergies, Biomarkers, Pathophysiology, Nutrition, Probiotics

Core tip: There are multiple clinical, pathophysiological and therapeutic commonalities between nonpulmonary allergic disease and inflammatory bowel disease (IBD). In particular, in terms of pathophysiology, histamine expression is upregulated in both IBD and allergic diseases. Ulcerative colitis, in particular, shows upregulation of the Th2 pathway which is seen in a large number of allergic phenomena including sinonasal disease. Both probiotics and nutritional interventions are promising therapies for both IBD and allergic disease (especially food intolerance, food allergies, and eczema) but these require more investigation. Recommending mothers breastfeed their infants, and for a longer duration also shows potential promise in prevention of both IBD and food allergies, but also requires further study.