Mechanisms of gastrointestinal reactions to food.

Much of the genetic information that modulates mucosal immune responses was encoded several million years ago and has subsequently been subjected to modifications selected by the impact of microorganisms and food antigens. Confronted with these challenges, the intestinal immune system has developed two arms: (1) immune exclusion performed mainly by secretory IgA antibodies to inhibit colonization of pathogenic microorganisms and penetration of harmful antigens; and (2) down-regulatory mechanisms to avoid local and peripheral overreaction (hypersensitivity) towards innocuous substances. The latter phenomenon is called oral tolerance and apparently explains why most individuals show no adverse immune reactions food. When the mucosal barrier function is insufficient, tolerance to dietary antigens is abrogated in genetically susceptible individuals. This is most likely to occur during the vulnerable period after birth before the immunoregulatory network has been established. Breast-feeding appears to be immunologically important during this period, not only to substitute for the infant's lacking secretory antibodies but also because of its immune-modulating effects.