THE POTENTIAL ROLE OF GASTROESOPHAGEAL REFLUX IN THE PATHOGENESIS OF FOOD-INDUCED WHEEZING

Severe reactive airways disease (RAD) in children is frequently associ ated with gastroesophageal reflux or food allergy. However a relations hip between these two confounding factors has yet to be investigated. We postulate that, in certain patients with micro-aspiration of gastri c contents into the airways, food allergens sensitize T cells in the p eribronchial lymphoid tissue and induce the production of food-specifi c IgE antibodies that sensitize airway cells. Subsequent exposure to t hese food allergens might then induce IgE dependent mediator release f rom mast cells as well as T cell and eosinophil activation, thus contr ibuting to airway inflammation and RAD. In the current report, we desc ribe the case of a patient with severe asthma who had food allergy and gastroesophageal reflux whose clinical findings support this hypothes is. We also provide additional evidence for a high rate of food sensit ization in patients with bronchopulmonary dysplasia (BPD), RAD and GER . We conclude that additional studies are warranted to examine the pos sibility that patients who have RAD and GER require an evaluation for food allergy.