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.
Aim of the study: Aim of this study was to evaluate whether fecal calprotectin (FC) can be used as noninvasive biomarker of allergic enterocolitis and be helpful in differentiating with other inflammatory gastrointestinal conditions. Material and methods: The retrospective study was performed on the group of 48 children, aged 1-36 months (mean 9.0 ±6.6) admitted to our Department for diagnostics of complaints from gastrointestinal tract. The inclusion criteria to analysis was the increased FC concentration (> 150 µg/g of stool) evaluated using ELISA method. Subjects were reviewed for the diagnosis, gastrointestinal symptoms, infectious parameters and allergic tests. The study group was then divided into three subgroups considering the cause of the increased FC concentration including 17 children with food allergy, 10 with infection and 14 with both of them. Seven children were excluded from the study due to the other diagnosis; 18 healthy, age comparable children, were qualified to the reference group. Results: FC concentration was significantly higher in the group of children with allergy (mean 892.3 ±791.4 µg/g, p < 0.001), infection (mean 742.2 ±900.7 µg/g, p = 0.046) and both diagnosis (mean 1088.7 ±528.3 µg/g, p < 0.001) in comparison to the reference group (mean 81.5 ±37.3 µg/g), but no significant statistical differences were found between subgroups regarding to the cause of gut inflammation (p > 0.05). The main cause of infection was Staphylococcus aureus (50.0%); of allergy-cow's milk. The concentration of C-reactive protein was higher in the group of children with infection compared to allergic patients (14.3 ±32.5 mg/l vs. 3.1 ±3.7 mg/l; p = 0.305). Conclusions: Food allergy as well as infection can be a cause of increased FC concentration. FC might only be useful as a screening test of allergic enterocolitis in infants and young children.
Food allergy has a significant negative impact on patients and their families, and it has become an important public health problem. Currently used diagnostic methods, such as skin prick tests (SPT) and determination of specific immunoglobulins E (sIgE), present limited sensitivity and specificity. Therefore, new tools are expected to improve the accuracy of the diagnostic work-up. A recent hypothesis of allergic reactions indicates a primary role of dysregulation of the epithelial barrier, which pioneers the role of biomarkers of intestinal damage in food allergy. The objective of this paper is to present the currently most promising biomarkers for the diagnosis, prognosis, and management of food allergy in children.
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