Abstract
Food allergy (FA) affects approximately 3 to 4% of the adult population in westernized countries. Suspected FA is even more prevalent and requires extensive diagnostic work-up. Within this study, we evaluated whether assessment of the integrity of the epithelial barrier by confocal laser endomicroscopy (CLE) during colonoscopy can be used as a screening tool to identify patients with FA. 60 patients with suspected FA were prospectively included. Serology with total and food-specific IgE, anti-tissue transglutaminase, skin prick testing, food intolerance tests, food intake registration and assessment of clinical complaints were performed. During colonocopy, standardized CLE was performed in the terminal ileum and at two colorectal sites. Analysis of CLE images included functional (i.e. presence of epithelial barrier dysfunction) and quantitative parameters of intestinal architecture. 27 of 60 patients (45%) were diagnosed with FA. Barrier dysfunction was analyzed on 65.837 ileal and on 93.251 colonic images. 96% of patients with FA exhibited functional and structural barrier defects while barrier dysfunction was found in only 33% of patients without FA (p < 0.0001). Visualizing barrier dysfunction with CLE for in vivo diagnosis of FA had a sensitivity and specificity of 96% and 67%, respectively, with a positive and negative prediction of 70% and 96%, respectively. Parameters intrinsic to the crypt architecture including crypt diameter, intercrypt distance, crypt lumen diameter and colonic vasculature were not different between patients with and without FA. CLE-based imaging of the intestinal barrier during colonoscopy might help in stratifying patients with suspected FA for further diagnostic work-up.
Highlights
Food allergy (FA) affects approximately 3 to 4% of the adult population in westernized countries
Patients with food allergy (FA) had significantly higher serum IgE levels (p = 0.00003) whereas serological expression of C-reactive protein (CRP), eosinophilic cationic protein (ECP), TNF, tryptase, histamine and diaminooxidase (DAO) as well as leukocyte counts were not different between patients with and without FA. Out of these 33 patients without FA, the following diagnoses were made after diagnostic work: microscopic colitis (n = 2), sorbitol intolerance (n = 2), histamine intolerance (n = 3), eosinophilic gastroenteritis (n = 1)
Since its introduction to the market more than a decade ago, confocal laser endomicroscopy (CLE) has emerged as a technology that allows for microscopy imaging in realtime in the GI tract but is the only imaging modality to date to functionally assess the integrity of the intestinal barrier
Summary
Food allergy (FA) affects approximately 3 to 4% of the adult population in westernized countries. We evaluated whether assessment of the integrity of the epithelial barrier by confocal laser endomicroscopy (CLE) during colonoscopy can be used as a screening tool to identify patients with FA. CLE-based imaging of the intestinal barrier during colonoscopy might help in stratifying patients with suspected FA for further diagnostic work-up. Used allergy tests such as skin prick testing or serum–radioallergosorbent tests (RASTs) exhibit only limited sensitivity and s pecificity[9] and measurements of total and allergen specific IgE levels are recommended to identify the causative food allergen, they are not diagnostic t hemselves[9]. We used CLE to visualize barrier dysfunction in patients with suspected food allergy under regular diet and explored whether CLE can be used as a screening tool to identify patients with FA in real time
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