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Extraintestinal Manifestations in Children With Gastrointestinal Food Allergy

Domínguez-Ortega, G.; Borrelli, O.; Meyer, R.; Dziubak, R.; De Koker, C.; Godwin, H.; Fleming, C.; Thapar, N.; Elawad, M.; Kiparissi, F.; Fox, A.T.; Shah, N.

Journal of Pediatric Gastroenterology & Nutrition: August 2014 - Volume 59 - Issue 2 - p 210–214
doi: 10.1097/MPG.0000000000000391
Original Articles: Gastroenterology

Objectives: The presence of extraintestinal manifestations (EIM) in children with gastrointestinal (GI) food allergy (GIFA) is greatly debated. In the present study we assessed the prevalence of EIM in children with GIFA and investigated whether their presence is helpful in the allergy-focused history-taking process.

Methods: The medical records of all children with a proven diagnosis of GIFA were reviewed along with those of children diagnosed as having inflammatory bowel disease (IBD) as controls. Data regarding age at onset, age at diagnosis, atopic family history, atopic comorbidities, GI symptoms, and EIM were recorded.

Results: Data from 436 children with GIFA and 74 children with IBD were included in the analysis. EIM were documented in 368 children with GIFA, including fatigue (53.0%), allergic shiners (49.1%), mouth ulcers (39.0%), joint pain/hypermobility (35.8%), poor sleep (34.4%), night sweats (34.4%), headache (22.7%), and bed-wetting (17.7%). The proportion of patients with EIM was higher in the GIFA group compared with that in the IBD group (368/436 [84.4%] vs 40/74 [54.1%]; P < 0.001). Segregating the GIFA group into children with and without atopic comorbidities, both atopic (276/30; 89.9%) and nonatopic (93/130; 71.5%) children showed higher proportion of EIM than children with IBD ([40/74; 54.1%], P < 0.01 and <0.05, respectively).

Conclusions: GIFA are commonly associated with a wide range of EIM, which appear to represent important and specific clinical features of this group of conditions. Their recognition in taking an allergy-focused history may play an important role for both diagnosis and management.

Department of Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust Institute of Child Health, London, UK.

Address correspondence and reprint requests to Neil Shah, MD, MRCP, Division of Mucosal Immunology, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Sick Children, Great Ormond Street, WC1N 3HZ London, UK (e-mail:

Received 7 January, 2014

Accepted 28 March, 2014

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The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,