Abstract
Diagnosis of non-IgE mediated food allergy presents a special challenge due to lack of a single, non-invasive diagnostic method. We selected three fecal biomarkers of allergic inflammation of gastrointestinal origin in order to improve the diagnostic process. Twenty-seven infants with symptoms of hematochezia were prospectively enrolled into this study. All patients underwent a complete differential diagnosis of rectal bleeding. Non-IgE mediated food allergy was confirmed by an open, oral food challenge. The control group included twenty-five infants with functional gastrointestinal disorders. Eosinophil-derived neurotoxin (EDN), tumor necrosis factor alpha (TNFα), and calprotectin concentration were measured in stools of all children by enzyme-linked immunosorbent assays (ELISA) using commercial kits. Median eosinophil-derived neurotoxin and calprotectin fecal levels were significantly higher in the study group than in the control group (p < 0.05). The difference of fecal tumor necrosis factor alpha concentration between both groups was not statistically significant (p > 0.05). The best diagnostic performance was reached in a combination of fecal calprotectin (fCal) and EDN i.e., 88.9% and 84%, respectively. Fecal EDN and fCAl are reliable tools in differentiating between food protein-induced allergic proctocolitis and gastrointestinal functional disorders in infants.
Highlights
Food allergy (FA) is defined as an occurrence of reproducible, clinical symptoms caused by an abnormal, immune response to food components [1]
Patients diagnosed with FA encompassed 73.5% of all children with hematochezia referred to the hospital
This prospective study presents a potential role of three selected non- invasive, fecal biomarkers measurement in improving the diagnosis of food protein-induced allergic proctocolitis (FPIAP) in children
Summary
Food allergy (FA) is defined as an occurrence of reproducible, clinical symptoms caused by an abnormal, immune response to food components [1]. Based on the pathophysiologic background, immune hypersensitivity reactions to food are categorized into two main groups: IgE-mediated and non-IgE-mediated, with both requiring a different diagnostic approach. The diagnosis of an IgE-mediated FA begins with a history of clinical symptoms, based on which skin pricks tests (SPT) and serum specific-IgE (sIgE) with potential allergens are carried out. Both methods present good sensitivity, but poor specificity [2]. The application of a highly sensitive component-resolved diagnosis (CRD) is limited to immediate reactions exclusively [2]. The panel of sIgE presents an additional value in predicting polysymptomatic allergy development [3]
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