Non-pulmonary allergic diseases and inflammatory bowel disease: A qualitative review

Abstract

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.