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May the activation of mast cells by IgG- food antigen complexes be the missing piece of irritable bowel syndrome puzzle?


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Abstract

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with multifactorial pathophysiology such as visceral hypersensitivity, intestinal dysmotility, brain-gut axis dysregulation, altered intestinal fluid secretion, impaired permeability, mucosal immune dysregulation, bacterial dysbiosis and psychological stress. Recent studies have suggested that activation of intestinal mast cells may play a role in many of these factors. On the other hand, from the beginning of this century, symptomatic improvements by elimination of foods with increased IgG antibodies have been reported in patients with IBS. These results may be explained by decreased activation of intestinal mast cells due to decreased IgG-food antigen immune complexes. Immune complex mediated mast cell activations occur when they bind to activating IgG receptors (FcγRs). If these antigens belong to some of the commonly consumed foods such as gluten-containing grains, bread yeast, cow’s milk and products, chicken egg or food additives like thickening agents, mast cell activation becomes continuous and may cause the disease to be treatment resistant. In this article, the role of increased IgG-food antigen complex dependent mast cell activation in the pathogenesis of IBS will be discussed.

Keywords

irritable bowel syndrome, mast cells, food-specific IgG antibodies, food additives, IBS, Irritable bowel syndrome, FODMAPs, fermentable oligosaccharidesdisaccharides monosaccharides and polyols, IgG, Immunoglobulin G

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