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Copyright ©The Author(s) 2015.
World J Gastroenterol. Jun 21, 2015; 21(23): 7089-7109
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7089
Table 1 Summary of studies on irritable bowel syndrome and atopy
Ref.Study designPatientsTopicMain results
White et al[83], 1991Case-control observational study11 IBS patients 11 healthy controls 11 organic gut diseases patientsIBS and bronchial hyper-responsivenessFEV1 reduction induced by methacholine in IBS patients was significantly greater than that observed in healthy subjects. FEV1 decrease in patients with organic disease was not different from that in normal subjects
Yazar et al[84], 2001Case-control observational study133 IBS patients 137 healthy controlsIBS and asthmaTwenty-one (15.8%) IBS patients and 2 (1.45%) patients from the control group had the diagnosis of asthma. FEV1, flow after 50% of the vital capacity has been exhaled, peak expiratory flow rate, and maximal mid-expiratory flow rate were significantly different
Jun et al[85], 2005Case-control observational study42 IBS patients 42 healthy controlsIBS and bronchial hyper-responsivenessNo statistical difference was found between the two groups with respect to FEV1, FVC, FVC/FEV1, and FEF(25-75)
Roussos et al[86], 2003Case-control observational study150 asthma patients 130 other pulmonary disease patients 120 healthy controlsIBS and asthmaIBS prevalence was significantly higher in asthmatics (62/150, 41.3%) than in subjects with other pulmonary disorders (29/130, 22.3%) and healthy controls (25/120, 20.8%). None of the asthma medications were associated with increased or decreased likelihood of IBS
Ozol et al[87], 2006Case-control observational study125 asthma patients 95 healthy controlsIBS and asthmaIBS was found in 29.6% and 12.7% (P < 0.005) respectively of asthma patients and healthy controls. Food allergy was reported in 7.2% and 2.1% (P > 0.05) respectively for the two groups. No significant association between asthma related parameters, IBS, and food allergy could be found
Powell et al[88], 2007Retrospective study7235 patients attending a general practiceIBS, asthma and allergic rhinitisIBS was more common in patients with asthma (9.9%) and allergic rhinitis (7.9%) compared to patients with chronic diseases (4.9%, P < 0.002 and 4.9%, P < 0.05 respectively) or the remaining non-asthmatic population (5.5%, P < 0.001 and 5.5%, P < 0.02 respectively)
Cole et al[89], 2007Nested case-control study91237 people with asthma 24518 people without asthmaIBS and asthmaIncidence of IBS among people with asthma was 20% higher than in non-asthmatic patients; no association was found between oral steroid intake and IBS among people with asthma
Huerta et al[90], 2002Population-based cohort study50000 people with asthma 50000 people without asthmaIBS and asthmaIBS incidence in the asthma cohort was 2.5 per 1000 persons/years and 2.0 in the general population, with a RR of 1.3. In the asthma cohort, oral steroid users had RR of 0.5 for developing IBS, without any difference between short- and long-term users
Panicker et al[91], 2008Case-control observational study138 asthma patients 145 healthy controlsIBS and asthmaA large proportion (39.13%) of asthmatics had IBS compared to controls (7.93%) (P < 0.001). IBS was reported in 87% of cases using inhalers, and in 13% with additional oral theophylline (P < 0.001). As many as 66.6% cases, had IBS with relatively short duration of asthma (1-5 yr, P < 000)
Hunskar et al[92], 2012Cohort study817 subjects exposed to giardia 1128 subjects not exposed to giardiaPost-infection IBS and asthmaIBS was found in 47.8% of subjects with asthma compared with 45.3% in those without asthma (P = 0.662) in the giardia exposed group. For controls, corresponding percentages were 23.9% and 12.2% (P < 0.001)
Tobin et al[93], 2008Prospective study125 consecutive: allergy/immunology (n = 39), gastroenterology (n = 36) general medicine (n = 50)IBS and atopic diseasesThe likelihood of IBS was significantly higher in patients with seasonal allergic rhinitis (2.67 times; P = 0.03), allergic eczema (3.85 times; P = 0.001), and depression (2.56 times; P = 0.04). Patients reporting atopic symptoms (seasonal allergic rhinitis, asthma, and allergic eczema) were 3.20 times (95%; P = 0.02) more likely to fulfill IBS criteria
Jones et al[94], 2014Retrospective study30000 patients from primary care medical recordsFGIDs and atopic diseasesIn patients suffering from IBS alone, functional dyspepsia alone and multiple functional gastrointestinal disorders, there was higher asthma prevalence compared to controls (OR = 1.43, 1.41 and 1.92 respectively)
Olén et al[96], 2014Birth cohort study2610 childrenRecurrent abdominal pain and atopic diseases in children237 (9%) children reported abdominal pain when 12 yr old. Asthma in the first two years of life and food allergy at age 8 yr were significantly associated with abdominal pain at 12 yr (P < 0.001). There was an increased risk of abdominal pain at 12 yr in children sensitized to food allergens at 4 or 8 yr
Smith et al[97], 1985Prospective study29 patients with perceived food hypersensitivitySelf-reported food hypersensitivity and allergy17 (60%) of the 26 patients were positive to skin prick tests to inhalant allergens
Lillestøl et al[98], 2010Prospective study71 patients with perceived food hypersensitivitySelf-reported food hypersensitivity and allergy66 (93%) patients suffered from IBS and 43 (61%) had atopic diseases (predominantly rhinoconjunctivitis). Atopic patients had increased density of IgE-bearing cells and intestinal permeability but gastrointestinal symptoms did not differ between groups (P = 0.02). IgE-positive cells and intestinal permeability did not differ between patients who were sensitized to inhalants and those who were only sensitized to food
Berstad et al[99], 2012Prospective study84 patients with perceived food hypersensitivitySelf-reported food hypersensitivity, IBS, chronic fatigue and fibromyalgia83 patient were diagnosed with IBS, 58% with severe symptoms. 85% reported symptoms suggestive of chronic fatigue and 71% fibromyalgia. These symptoms could not be explained either by IgE-mediated food allergy or by organic pathology
Lind et al[100], 2013Case-control observational study38 patients with self-reported food allergy 42 healthy controlsSelf-reported food hypersensitivity, IBS, fatigueFIS scores were higher in patients (median 85.0, interquartile range 36.8-105.3) than in controls (median 14.0, interquartile range 3.0-29.0, P ≤ 0.0001)
McKee et al[12], 1987Observational study40 IBS patientsIBS and elimination dietPatients received an antigen-exclusion. 15% showed improvement in their IBS-symptoms. A further 12.5% reported increased well-being but this did not seem to be related to the exclusion of any particular food. The diarrhea prevalent subgroup responded the best (3/8) whereas the constipation subgroup consistently failed to improve
Heizer et al[17], 2009ReviewNAIBS and elimination diet25% of IBS patients reported their symptoms may be caused or exacerbated by one or more dietary components. Diet restricted in fermentable, poorly absorbed carbohydrates, including fructose, fructans, sorbitol, and other sugar alcohols seemed to be beneficial
Zar et al[101], 2005Prospective study25 IBS patientsIBS and elimination dietPatient IgG4 antibodies to milk, eggs, wheat, beef, pork and lamb were measured, and were commonly elevated. Significant improvement was reported in pain severity (P < 0.001), pain frequency (P = 0.034), bloating severity (P = 0.001), satisfaction with bowel habits (P = 0.004) and effect of IBS on life in general (P = 0.008) at 3 and 6 mo of elimination diet
Atkinson et al[102], 2004Randomized trial150 IBS patientsIBS and elimination dietPatients received either a diet excluding all foods to which they had raised IgG antibodies or a sham diet for 3 mo. The true diet resulted in a 10% (26% in fully compliant) greater reduction in symptom score than the sham diet
Bolin[103], 1980Randomized trial20 patients suffering from persistent diarrheaIBS and DSCG18 patients reported significant improvement in diarrhea while taking sodium cromoglycate and this did not correlate with the presence of other atopic diseases, history of food intolerance, or lactase deficiency
Paganelli L et al[104], 1990Prospective study14 IBS patientsIBS, elimination diet and DSCG7 (50%) patients improved after elimination diet with (5/7) and without (2/5) DSCG
Lunardi et al[105], 1991Double-blind cross-over trial20 IBS patientsIBS and DSCG18 patients completed the study; analysis of patients' diary card scores showed a statistically significant difference in favor of DSCG
Stefanini et al[106], 1992Prospective study101 IBS patients (diarrhea type)IBS, atopy and DSCGPatients were then tested for 48 commercial alimentary antigens by SPT and underwent 8 wk of oral DSCG. Symptom improvement was observed in 67% of the 74 SPT-positive patients, whereas only in 41% of the 27 SPT-negative patients
Stefanini et al[107], 1995Multicenter trial428 IBS patients (diarrhea type)IBS, elimination diet and DSCGIBS symptoms improved in 60% of patients treated with elimination diet and in 67% of those treated with DSCG. In both groups clinical results were significantly better in the patients positive to the skin prick test than in the negative ones
Leri et al[108], 1997Randomized study120 IBS patients (diarrhea type)IBS, elimination diet and DSCG66 patients had positive SPT; they were randomly treated with elimination diet (30) or with elimination diet plus DSCG. 18 (60%) of the 30 patients that had received the only exclusion diet reported symptom improvement, whereas 32 of the 36 patients (89%) who had undergone both dietary and DSCG treatments showed an improvement that was clinically and statistically significant (P = 0.01)