IBS, Eczema, Hayfever, and Migraine: Could They Share a Common Driver — and Could Enterosgel® Be Helping With All of Them?

Enteromed Editorial Team  ·  July 2026  ·  8 min read

When we completed the RELIEVE IBS-D trial — our landmark 440-patient NHS randomised controlled trial of Enterosgel® for IBS with diarrhoea — we published our results in GUT journal, where they were named one of the top 10 studies of 2022. But inside that dataset, something else was quietly waiting. Something we were not looking for. Something that, when we found it, stopped us in our tracks.

A subgroup of our patients had something in common beyond IBS-D. They also had eczema, hayfever, allergic rhinitis, migraine, or food intolerance. Conditions that, on the surface, have nothing to do with each other. Yet when we looked at how these patients responded to Enterosgel®, the numbers were striking.

Note: This subgroup analysis is an exploratory finding from the RELIEVE IBS-D trial (published GUT 2022). It was not a pre-specified primary outcome and should be interpreted as hypothesis-generating. The overall trial results remain the primary evidence base for Enterosgel® in IBS-D. The figures above reflect the rigorous double-blind primary endpoint. In the subsequent open-label phase, 76% of all patients reported adequate overall relief of their IBS symptoms, with significant improvements in quality of life across urgency, stool consistency, abdominal pain, and bloating.

The patients who responded best were the ones with allergic conditions

In the overall RELIEVE IBS-D trial, Enterosgel® produced a 37.4% responder rate versus 24.3% on placebo — a statistically significant, clinically meaningful result that led directly to NHS Drug Tariff listing and a first-line recommendation in The Lancet Gastroenterology & Hepatology in 2024.

But when we looked specifically at the patients who also had allergic or atopic conditions — eczema, hayfever, allergic rhinitis, migraine, headaches, or food intolerances — the Enterosgel responder rate jumped to 52.5%. The placebo rate in that same group was 28.1% — almost identical to the overall placebo rate. The placebo effect was not inflated. The Enterosgel effect was genuinely stronger.

That is a near 90% relative improvement in response rate compared to the overall trial. And it raises an obvious question: why would patients with eczema, hayfever, or migraine respond better to a gut treatment for diarrhoea?

Meet the mast cell — the immune cell that may be connecting all of these conditions

The hypothesis — emerging from clinical discussion with leading gastroenterologists and supported by a growing body of published immunological research — centres on a specific immune cell: the mast cell.

Mast cells are tissue-resident immune cells found throughout the body — particularly in the gut lining, the skin, and around sensory nerves. When activated, they release a cascade of inflammatory mediators: cytokines including TNF-α and IL-1β, proteases including tryptase, prostaglandins, leukotrienes, and histamine. These mediators drive inflammation not just locally but systemically, through the gut-brain axis, the gut-skin axis, and via sensory nerve pathways.

Mast cell activation has now been formally implicated in IBS, atopic dermatitis, hayfever, allergic rhinitis, and migraine — all conditions that were overrepresented in our higher-responding subgroup. A 2022 study published in Neurogastroenterology & Motility found that IBS is strongly associated with primary and idiopathic mast cell disorders. A 2024 review in the Journal of Allergy and Clinical Immunology identified the mast cell–sensory neuron axis as a central driver of both atopic dermatitis and neurological pain. A 2025 international review confirmed that intestinal dysbiosis promotes mast cell-oriented inflammation along the gut-skin, gut-brain, and gut-lung axes simultaneously.

The hypothesis, then, is this: in patients with allergic or atopic conditions, mast cell activation in the gut may be driving both the IBS-D symptoms and the systemic inflammatory burden that manifests as eczema, hayfever, or migraine. Enterosgel®, by adsorbing the bacterial toxins and inflammatory mediators in the gut that trigger mast cell activation, may be reducing that burden at its source — which would explain why this subgroup responded so much better.

What the laboratory evidence shows

This hypothesis is not without scientific grounding. In 2019, a peer-reviewed laboratory study published in Scientific Reports (Nature Portfolio) — co-authored by Dr Carol Howell and Professor Sergey Mikhalovsky of the University of Brighton — confirmed that Enterosgel® effectively adsorbs C. difficile toxins A and B, E. coli endotoxin, and excess bile acids. The same study confirmed that Enterosgel® adsorbs significantly less of small-molecule drugs than activated charcoal — its selectivity increases with molecular weight, targeting large harmful molecules preferentially.

In 2025, a study by Symriti Kaur-Paneser at Imperial College London — awarded the Falk Foundation/Guts UK Medical Student Prize 2025 — specifically investigated Enterosgel®’s adsorption capacity for molecules relevant to ulcerative colitis. The study confirmed that Enterosgel® adsorbs TNF-α and IL-1β — two of the key inflammatory cytokines released by activated mast cells, and two of the primary drivers of both gut inflammation and atopic skin disease.

Why what happens in your gut shows up on your skin

The gut-skin axis is a bidirectional communication pathway between gut health and skin inflammation that is now well-established in the scientific literature. When the gut barrier is compromised — a state often referred to as increased intestinal permeability or “leaky gut” — bacterial toxins, food allergens, and metabolic waste products leak into the bloodstream and trigger a systemic immune response. This systemic inflammatory burden frequently manifests on the skin as atopic dermatitis flares.

In patients with IBS-D, a higher density of mast cells has been consistently observed in the gut lining, accompanied by increased degranulation. It is now understood that in subjects with IBS, intestinal barrier dysfunction is directly correlated with mast cell activation — creating a reinforcing cycle where gut permeability triggers mast cells, which release mediators that further damage the gut barrier, which allows more triggers through.

For patients who also have atopic skin conditions, this cycle does not stay in the gut. The same mediators travel systemically, activating skin mast cells and driving the inflammation that causes eczema flares, hayfever, and — via sensory nerve pathways — migraine.

Enterosgel® and atopic dermatitis: what has already been studied

The use of oral intestinal adsorbents in the treatment of atopic skin conditions is not new. Clinical studies in paediatric populations have been investigating this connection for over two decades — with some striking results that have informed our own research direction.

Professor Malanicheva and colleagues published clinical data on Enterosgel® in children with atopic dermatitis showing a 5-fold reduction in SCORAD scores (from 54 to 12) and a 12-fold decrease in plasma endotoxin levels. A separate study of 40 children with atopic dermatitis complicated by fungal infection showed an overall therapeutic efficacy of 87.5% in those receiving Enterosgel®, with the period of acute exacerbation nearly halved.

Crucially, several studies measured IgE levels before and after treatment. IgE is the key antibody driving allergic responses and mast cell activation. Enterosgel® treatment was associated with a significant reduction in IgE — suggesting that by reducing the gut-derived antigenic load, it was measurably dampening the allergic immune response.

These findings from earlier research, while not UK-based randomised controlled trials, are consistent with the hypothesis and informed the design of our own HRA-registered UK protocol for an atopic dermatitis study (IRAS ID 221883, ISRCTN12307286) — which has full MHRA and Research Ethics Committee approval and is ready to proceed.

We have an approved UK clinical trial protocol. We need a chief investigator.

Enteromed Ltd, in collaboration with Bioline Products s.r.o., has a fully registered, MHRA-approved, REC-approved protocol for a randomised, multi-centre UK study to assess the efficacy, tolerability, and safety of Enterosgel® in the treatment of acute atopic dermatitis in adults (IRAS ID 221883, ISRCTN12307286). The protocol was approved by the North West — Preston Research Ethics Committee and is registered on the Health Research Authority (HRA) website.

The study design includes 44 adult patients with acute atopic dermatitis, SCORAD assessment, POEM questionnaire (patient-reported outcomes), and blood sampling for allergic antibodies, endotoxin levels, and inflammatory markers — designed precisely to test the gut-skin-mast cell hypothesis in a rigorous clinical setting.

If you have IBS-D alongside eczema, hayfever, or migraine

The hypothesis is exactly that — a hypothesis. We are not claiming that Enterosgel® treats eczema, hayfever, or migraine. We are sharing an observation from our own clinical trial data that patients with these conditions responded better to Enterosgel® for their IBS-D, and we are transparently explaining the scientific thinking behind why that might be.

What we can say is that Enterosgel® is clinically proven, NHS-prescribable, and safe for long-term use. It is indicated for IBS-D and acute diarrhoea. If you have IBS-D and also experience eczema, hayfever, or migraine, your clinician may find it particularly worth discussing.

And if you are a patient who has tried Enterosgel® for your IBS-D and noticed any improvement in your skin, hayfever, or headaches — we would genuinely like to hear from you. Patient experiences like yours are exactly what shapes future clinical research.