Immunoglobulin E and Eosinophilic Cationic Protein in Segmental Lavage Fluid of The Small and Large Bowel Identify Patients With Food Allergy

Schwab, Dieter; Raithel, Martin; Klein, Patricia; Winterkamp, Sandra; Weidenhiller, Michael; Radespiel-Troeger, Martin; Hochberger, J; Hahn, Eckhart G.

doi:10.1111/j.1572-0241.2001.03467.x

Cited by 47 publications

(56 citation statements)

References 22 publications

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“…However, if these tests are negative, the reactions may still be IgE-mediated [12]. Several recent studies have shown that IgE may be detectable in intestinal lavage fluid and biopsy specimens even if the amount is too small or transient to be detectable in blood [5,6,7]. Hence, apparent non-IgE-mediated adverse reactions to food may actually be local IgE-mediated allergic reactions of the intestine [3, 4].…”

Section: Discussionmentioning

confidence: 99%

“…Immediate responses such as luminal influx of fluid and mucosal oedema have not been described in non-IgE-mediated intestinal food allergy. However, studies indicate that local IgE may be detectable in allergic reactions of the intestines [5,6,7], suggesting that immediate hypersensitivity reactions might be IgE-mediated despite negative skin prick test (SPT) and lack of systemic food-specific IgE.…”

Section: Introductionmentioning

confidence: 99%

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Food Hypersensitivity Reactions Visualised by Ultrasonography and Magnetic Resonance Imaging in a Patient Lacking Systemic Food-Specific IgE

et al. 2006

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Background: Abdominal complaints related to food intake might be due to hypersensitivity. A firm diagnosis of food allergy is often difficult to establish, particularly in the absence of systemic food-specific IgE. Using ultrasonography and magnetic resonance imaging (MRI) we were able to visualise the intestinal response in one such case. Methods: A 24-year-old female presented with self-reported food hypersensitivity, particularly related to the intake of egg. Nausea and diarrhoea were predominant symptoms. Double-blind placebo-controlled food challenge with raw egg was positive, but all other conventional tests of food hypersensitivity, including skin prick test, total and food-specific IgE in serum, were negative. A thorough investigation programme could not reveal any organic disease of the gastrointestinal tract. We extended the evaluation to include two new provocation tests, where intestinal wall thickening and the amount of luminal liquid were monitored by external abdominal ultrasound and MRI. Results: Both ultrasound and MRI investigations indicated intestinal wall thickening and influx of large amounts of fluid into the proximal small intestines within 10 min of duodenal challenge with egg. The response was associated with abdominal pain and bloating. Conclusions: The response to provocation was typical of an immediate allergic reaction. Our results indicate that local food-induced hypersensitivity reactions can occur in the gut in the absence of systemic indications of IgE-mediated allergy. Abdominal ultrasonography and MRI might become valuable tools for documenting such responses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Food Hypersensitivity Reactions Visualised by Ultrasonography and Magnetic Resonance Imaging in a Patient Lacking Systemic Food-Specific IgE

et al. 2006

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“…Food allergy was only diagnosed when food-specific sensitization was detectable by positive skin-prick test, serum IgE (≥class II) or proof of intestinal IgE by endoscopically guided segmental lavage [2,16,20] in conjunction with a reproducible clinical adverse reaction to the food antigen(s) applied. Food antigens identified were cereals, soy, nuts, milk, beef, pork, egg and pollen-cross reactive allergens (apple, celery, etc.).…”

Section: Methodsmentioning

confidence: 99%

“…[1,2,3]. One possible pathway represents the degranulation of mast cells and the consecutive release of mediators and proteases followed by an enhancement of the intestinal mucosal permeability resulting in an increased influx of potential allergens and harmful microbes into the intestinal tissue [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

Mast Cell Tryptase Levels in Gut Mucosa in Patients with Gastrointestinal Symptoms Caused by Food Allergy

Hagel

deRossi

Zopf

et al. 2012

Int Arch Allergy Immunol

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Background and Aims: Mast cells, which are important effector cells in food allergy, require a special histologic treatment for quantification in endoscopic gastrointestinal samples. The objective of this study was to investigate whether mast cell tryptase (T), a typical mast cell-associated marker, may help to detect patients with food allergy. Methods: Mast cell T was investigated from 289 colorectal samples of 73 controls, 302 samples from 43 patients with food allergy and gastrointestinal symptoms, and 72 samples from 12 patients with partial or complete remission of allergic symptoms. Endoscopically taken samples were immediately put into liquid nitrogen, mechanically homogenized by a micro-dismembrator with three homogenization steps and tissue T content (ng T/mg wet weight) was measured by fluoroenzyme immunoassay. Results: Tissue T levels from the lower gastrointestinal tract were significantly elevated (p < 0.0001) in patients with manifest gastrointestinal allergy (median: 55.7, range: 9.3–525.0) compared with controls (median: 33.5, range: 8.0–154.6). A subgroup of 12 patients with remission of allergy showed markedly decreased symptom scores and mucosal T levels after more than 1 year of antiallergic therapy (pretreatment median: 54.1, range: 37.0–525.0 and posttreatment median: 28.4, range: 19.8–69.1; p = 0.01). Conclusions: High T levels in the gut of food-allergic patients support the role of stimulated mast cells or an increased mast cell number.

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“…4). Analysis of the lavage fluid (results are given per mg of protein) revealed increased production of immunoglobulin E (IgE) locally in the gut (4.2 U, normal < 0.35 [2,3]) and increased eosinophilic cationic protein levels (18.8 µg, normal < 4.5). Histologic examination was able to rule out infection, mastocytosis, and eosinophilic gastroenteritis, but showed increased numbers of mast cells (1066/mm 2 , normal < 600) and eosinophils (876/mm 2 , normal < 200).…”

mentioning

confidence: 99%

Potential utility of double-balloon enteroscopy for the diagnosis and evaluation of gastrointestinally mediated allergy

et al. 2014

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Immunoglobulin E and Eosinophilic Cationic Protein in Segmental Lavage Fluid of The Small and Large Bowel Identify Patients With Food Allergy

Abstract: In endoscopically guided segmental lavage fluid, IgE and ECP/protein are increased in patients with food allergy. These measurements seem to offer an attractive diagnostic tool and may serve as a screening method.

Cited by 47 publications

References 22 publications

Food Hypersensitivity Reactions Visualised by Ultrasonography and Magnetic Resonance Imaging in a Patient Lacking Systemic Food-Specific IgE

Food Hypersensitivity Reactions Visualised by Ultrasonography and Magnetic Resonance Imaging in a Patient Lacking Systemic Food-Specific IgE

Mast Cell Tryptase Levels in Gut Mucosa in Patients with Gastrointestinal Symptoms Caused by Food Allergy

Potential utility of double-balloon enteroscopy for the diagnosis and evaluation of gastrointestinally mediated allergy

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