Intestinal permeability in children with food allergy on specific elimination diets

Abstract

BACKGROUND Children with food allergy have been shown to have increased small intestinal permeability (IP) following ingestion of the offending food as well as during elimination diets. We investigated IP in asymptomatic food-allergic children during an elimination diet to identify clinical characteristics associated with altered IP. METHODS Urinary recovery ratios of lactulose and mannitol (L/M) were determined five hours following ingestion of 7.5 g of lactulose and 2 g of mannitol in 131 cow’s milk- and egg-allergic children. An L/M ratio of ≥0.025 was considered abnormal based upon previously established laboratory internal references. A chart review was conducted to assess the clinical characteristics of these patients. RESULTS A total of 50 (38%) of the 131 children (median 6.7, range 4.8 – 8.9 years); 66.2% male) with food allergy had elevated IP while asymptomatic on strict elimination diets. Age and height negatively correlated with IP. However, in the regression model analysis, abnormal IP was associated with shorter stature independently of age. Otherwise, food allergic patients with increased IP were comparable in gender, nutritional status, age of onset of food allergy, history of reactions, atopic diseases and family history of food allergies to those with normal IP. CONCLUSIONS Elevated IP was found in about one-third of asymptomatic food-allergic children on elimination diets and was associated with shorter stature. Our results suggest that increased IP may be an intrinsic trait in a subset of food allergic children. However, large, prospective studies are necessary to determine the role of impaired intestinal barrier in food allergy.

Increasing Small Intestinal Permeability Worsens Colitis in the IL-10−/− Mouse and Prevents the Induction of Oral Tolerance to Ovalbumin

“…Strikingly, simply increasing small intestinal paracellular permeability induced a systemic and local immune response to OVA. 34 Interestingly, our experiments showed that increasing small intestinal permeability in a healthy host increases antigen-specific IgE in the small intestine, suggesting a possible role of small intestinal permeability in food allergy development. In a host genetically predisposed to inflammation, such as the IL-10 2/2 mouse, or in the presence of a bacterial antigen instead of a dietary one, the immune response in the presence of an increased small intestinal permeability may be one of cell-mediated immunity instead of a humoral response, leading to a chronic inflammatory state and tissue injury.…”

Colonization of germ-free mice with a mixture of three lactobacillus strains enhances the integrity of gut mucosa and ameliorates allergic sensitization

“…Along these lines, increased gut permeability has been found in children with food allergies 50 and it has also been recently detected in asthmatic patients. 51 The homeostasis of the intestinal epithelium is maintained by a complex interplay of multiple regulatory mechanisms.…”

Urinary Metabolomics in Pediatric Obesity and NAFLD Identifies Metabolic Pathways/Metabolites Related to Dietary Habits and Gut-Liver Axis Perturbations

“…Lactulose/mannitol ratios (L/M ratio) were considered abnormal when they exceeded 0.03 [22]. Small intestinal bacterial overgrowth was identified using a hydrogen breath test (H2BT) apparatus (Bedfont Scientific Ltd., Maidstone, Kent, UK).…”