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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1595-1600

Mucosal Immunity

Lloyd Mayer, MD

From the Department of Medicine and Immunobiology, Mount Sinai School of Medicine, New York, New York

Food allergy is the manifestation of an abnormal immune response to antigen delivered by the oral route. Normal mucosal immune responses are generally associated with suppression of immunity. A normal mucosal immune response relies heavily on a number of factors: strong physical barriers, luminal digestion of potential antigens, selective antigen sampling sites, and unique T-cell subpopulations that effect suppression. In the newborn, several of these pathways are not matured, allowing for sensitization rather than suppression. With age, the mucosa associated lymphoid tissue matures, and in most individuals this allows for generation of the normal suppressed tone of the mucosa associated lymphoid tissue. As a consequence, food allergies are largely outgrown. This article deals with the normal facets of mucosal immune responses and postulates how the different processes may be defective in food-allergic patients.

Key Words: gastrointestinal allergy • food allergy • food hypersensitivity • oral tolerance • mucosal immunology

Abbreviations: sIgA, secretory immunoglobulin A • GI, gastrointestinal • MALT, mucosa-associated lymphoid tissue • Ag, antigen • IgE, immunoglobulin E • IEC, intestinal epithelial cell • SC, secretory component • IgM, immunoglobulin M

Received for publication Sep 11, 2002; Accepted Oct 30, 2002.


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