Gastrointestinally mediated food allergy causing Spondyloarthritis-like disease

Gastrointestinally-mediated food allergy (GMA) incidentally may cause non-erosive oligoarthritis. A 56-year-old woman with seronegative spondyloarthritis observed arthritic flares following ingestion of certain foods. Blood analyses were unremarkable. Segmental gut lavage revealed plasmacellular infiltrates and eosinophilia in terminal ileum. Food allergen-specific IgE-analysis of lavage fluid showed significant polyvalent intestinal IgE-sensitization (>0.35kU/mg protein) towards wheat, rye, egg, soybean, pork, beef, nuts. Repeated exposure to the aforementioned foods caused arthritis within 48 hours; elimination diet engendered long-term remission. Seronegative local IgE-mediated GMA (type I) was diagnosed. Especially seronegative rheumatoid arthritis and undifferentiated oligoarthritis should be scrutinized for food-related muscoloskeletal symptoms before initiating immunosuppression.