Eosinophil-Derived Neurotoxin, Tumor Necrosis Factor Alpha, and Calprotectin as Non-Invasive Biomarkers of Food Protein-Induced Allergic Proctocolitis in Infants

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.

Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

“…Children with FA demonstrated significantly higher FC and EDN levels than the controls ( p < 0.05). The authors found the best diagnostic performance in a combination of FC and EDN (88.9% and 84%) respectively and concluded that FC and EDN are reliable tools in differentiating between FPIAP and gastrointestinal functional disorders in infants [ 82 ].…”

Fecal Calprotectin and Eosinophil-Derived Neurotoxin in Children with Non-IgE-Mediated Cow’s Milk Protein Allergy

“…Two additional clinical cases have been reported [16,17], in which fEDN levels increased significantly after an oral challenge. Recently, a prospective study in infants 1-12 months of age found that median fEDN and fCP levels were significantly higher in 27 non-IgE-mediated food allergy (85% CMPA) children with hematochezia compared to a control group with functional disorders [18].…”

Non-IgE-Mediated Gastrointestinal Food Protein-Induced Allergic Disorders. Clinical Perspectives and Analytical Approaches

“…From the panel, they found EDN to be the most promising, highlighting as well the obvious need for studies with a higher population to confirm the results [88]. Other studies analyzing different combinations of these proteins also single out EDN as a potential biomarker for the diagnosis of these pathologies [92][93][94].…”