Source:Annals of Allergy, Asthma & Immunology
Author(s): Nazanin Samadi, Martina Klems, Eva Untersmayr
ObjectiveThe contribution of a dysfunctional intestinal barrier to the onset and progression of a variety of intestinal and extra-intestinal inflammatory diseases is well established. However, the role of the intestinal barrier function in food allergy is less evident.Data SourcesA MEDLINE search identified relevant studies investigating the role of intestinal permeability in food hypersensitivity.Study SelectionsThis review aimed at integrating cutting edge knowledge from different research fields with focus on the gastrointestinal barrier to evaluate its impact on food adverse reactions.ResultsThe different layers of the gastrointestinal barrier are responsible for separation of immunologically active food compounds from immune induction sites in the intestinal tract. In the intestinal lumen, commensals were revealed to induce enterocyte and immune cell maturation and formation of a tight epithelium, while the host immune response shapes microbiota composition. Located directly above the epithelium, the mucus layer forms a physical barrier preventing epithelial contact and mucus proteins were demonstrated to deliver antigen-specific tolerogenic stimuli to subepithelial innate immune cells. Moreover, the multiprotein complex sealing the intercellular space between epithelial cells forming a tight epithelial barrier was found to be influenced by allergic immune responses. However, not only intestinal barrier dysfunction, but also impaired gastric protein degradation was reported to contribute to food allergy. Gastric acid suppression by anti-ulcer medication was repeatedly described to induce food allergy and to facilitate food adverse reactions in already sensitized individuals.ConclusionsA functional gastrointestinal barrier is of paramount importance to prevent immunologically mediated food hypersensitive reactions.
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