Patients with Subjective Food Hypersensitivity: The Value of Analyzing Intestinal Permeability and Inflammation Markers in Gut Lavage Fluid

Abstract

Background/Aim: Subjective food hypersensitivity is prevalent in the general population. The aim of this study was to seek objective evidence of food hypersensitivity by analyzing intestinal permeability and inflammation markers in gut lavage fluid. Methods: Fifty-two patients with abdominal complaints self-attributed to food hypersensitivity were examined by skin prick test, serum IgE analysis, double-blind, placebo-controlled food challenge (DBPCFC), and intestinal lavage. The results were compared with those of 44 patients without food hypersensitivity. Neither the patients nor the controls had organic diseases that could explain their symptoms. Intestinal lavage was performed by administering 2 liters of isotonic polyethylene glycol (molecular weight 3,350 daltons) solution containing 50 µCi of [⁵¹Cr]EDTA through a nasoduodenal tube. The first clear fluid passed per rectum was collected and analyzed for histamine, eosinophilic cationic protein (ECP), tryptase, and calprotectin. The intestinal permeability was assessed by determining the 5-hour urinary excretion of [⁵¹Cr]EDTA. Calprotectin was also analyzed in native faecal samples. Results: The ECP concentration in gut lavage fluid was significantly higher in the patients than in the controls (p = 0.007), but the overlap between groups was large. Food hypersensitivity was confirmed by positive DBPCFC in only 4 patients. On average, histamine and ECP concentrations were high in these patients. Tryptase, intestinal permeability, and faecal and lavage calprotectin levels were normal. Conclusions: Very few patients had objective evidence of food hypersensitivity. Analyzing intestinal permeability and inflammation markers in gut lavage fluid did not contribute to the diagnosis, but further studies on histamine and ECP are warranted.

Effects of Seal Oil on Meal-Induced Symptoms and Gastric Accommodation in Patients with Subjective Food Hypersensitivity: A Pilot Study

“…An oral lactose tolerance test analysing blood glucose response was performed to exclude lactose malabsorption. Intestinal permeability and calprotectin in gut lavage fl uid were examined to exclude IBD (Arslan et al 2004a). …”

Histamine in food: is there anything to worry about?

“…Jansen et al [50], who evaluated clinical data published during the last 35 years on the relationship between the adverse effects and amine contents of food, found no scientific basis for dietary recommendation concerning amines. Food allergy, on the other hand, affects at least 2-6% of the population [28], with 25% believing they suffer from it [38]. It can be primary food hypersensitivity or caused by primary sensitization to airborne allergens resulting in cross-reactive IgE antibodies to certain foods.…”

“…It affects as much as ∼6% of infants below 3 years and ∼2% of the general population [28], although self-reported prevalence is much higher [38,39]. It is divided into three groups: IgE-mediated food allergy (type I), mixed IgE-mediated food allergy (type II) and non-IgE-mediated food allergy (type III) [40].…”

“…The exposure to the antigen triggers mast cell degranulation and release of several mediators, including histamine, platelet-activating factor, leukotrienes and prostaglandins, which evoke allergic reactions [40]. The foods which most commonly elicit anaphylactic reactions are cow's milk, hen's eggs, nuts, fish, seafood and pollen-related fresh fruits and vegetables [28,38,39]. Clinical manifestations of food allergies include gastrointestinal symptoms, such as nausea, vomiting, abdominal pain and diarrhoea, and general symptoms, such as rhinitis, asthma, oedema, hypotension, itching, urticaria (hives), dermatitis/eczema, bronchospasm and, in severe cases, anaphylactic shock [39,40,41].…”

Rectal Effluent as a Research Tool

“…It is also possible that any markers found in lavage fluid could ultimately be translated into stool markers in a final test. [68] Other Studies Levels of serotonin [67] histamine, tryptase, calprotectin, and eosinophilic cationic protein (ECP) [68] have been measured in WGLF samples in studies of subjective food hypersensitivity but none of these turned out to be a reliable marker, although ECP and histamine may warrant further study.…”