Persistent diarrhea as manifestation of gastrointestinal food allergy in young children: diagnostic possibilities

Abstract

Persistent diarrhea can be a sign of a number of medical conditions, including a gastrointestinal food allergy. Diagnosis in childhood is not very informative, since allergic diseases at this age often have a non-IgE-dependent mechanism of development. Objective. To study the diagnostic value of the fecal eosinophilic neurotoxin test for the diagnosis of gastrointestinal food allergy in young children with persistent diarrhea. Material and methods. The authors examined 70 young children (from 1 month to 3 years) with persistent diarrhea and 20 conditionally healthy children of the same age without burdened allergic background. They determined fecal eosinophilic neurotoxin levels in all children. The children were divided into 2 groups according to the results of this examination: Group with normal level of neurotoxin and Group with increased level of neurotoxin. Results. The physical development of children with persistent diarrhea with high levels of eosinophilic neurotoxin is often assessed as low or very low. With persistent diarrhea, blood and mucus in the stool was significantly more often detected in children with a high level of eosinophilic neurotoxin. Persistent diarrhea with an increased level of eosinophilic neurotoxin, was significantly more often combined with atopic dermatitis reflecting its allergic nature. The total IgE test turned out to be a highly specific marker of the allergic nature of persistent diarrhea, however, it has a low sensitivity and it is positive only in 26.3% of children with an increased eosinophilic neurotoxin. This fact confirms the non-IgE dependent pathogenetic mechanisms of gastrointestinal allergy. Conclusion: The study demonstrated a high differential diagnostic value of the eosinophilic neurotoxin test in the feces of children with persistent diarrhea. The authors revealed a statistical interconnection of a high level of eosinophilic neurotoxin and other markers of allergy. The results obtained substantiate the advisability of the eosinophilic neurotoxin test as a non-invasive method in the diagnosis of gastrointestinal food allergy.