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Intestinal permeability and fecal eosinophil-derived neurotoxin are the best diagnosis tools for digestive non-IgE-mediated cow’s milk allergy in toddlers

  • Nicolas Kalach , Nathalie Kapel EMAIL logo , Anne-Judith Waligora-Dupriet , Marie-Christine Castelain , Marie Odile Cousin , Christine Sauvage , Fatimata Ba , Ioannis Nicolis , Florence Campeotto , Marie José Butel and Christophe Dupont
Published/Copyright: May 11, 2012
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 51 Issue 2

Abstract

Background: Food allergy is a common problem in France involving 4%–6% of toddlers. As opposed to IgE-mediated cow’s milk allergy (CMA), delayed-onset CMA, mostly, non-IgE-mediated, remains difficult to diagnose in toddlers. Our study assessed the diagnostic performances of intestinal permeability and of fecal markers, in comparison with the standard allergic work-up in children referred for CMA diagnosis.

Methods: Twenty-five consecutive children, mean age (standard deviation) 6.3 months (4.8) with digestive and/or extra-digestive manifestations suggesting CMA, were prospectively studied based on a standardized allergic work-up (specific cow’s protein IgE and IgG, skin prick test, atopy patch test and oral open cow’s milk challenge) and digestive work-up including fecal microbiota analysis, intestinal permeability determination (urinary lactitol/mannitol ratio) and fecal markers measurement, i.e., α1-antitrypsin, tumor necrosis factor-α, calprotectin, β-defensin2, secretory IgA and eosinophil-derived neurotoxin (EDN). Receiver operating characteristic (ROC) curves were calculated for all markers in order to define cut-off levels.

Results: The cow’s milk challenge was positive in 11 children and negative in 14. The global test performances, i.e., the number of true positive+negative cases/the total number of cases, were 76% for intestinal permeability; 72% for fecal EDN; contrasting with atopy patch test, 68%; IgE, 60%; skin prick test, 55% and IgG, 52%.

Conclusions: In this routine diagnosis allergy work-up for CMA in toddlers, the best efficacy was seen for intestinal permeability compared to IgE, IgG, skin prick test and atopy patch test. Moreover, fecal EDN in a single spot sample displayed a similar performance.

Keywords: cow’s milk allergy; eosinophil-derived neurotoxin; fecal biomarkers; gut microbiota; intestinal permeability
Corresponding author: Pr. Nathalie Kapel, Laboratoire de Coprologie Fonctionnelle, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75013 Paris, France Phone: +33 1 42162652, Fax: +33 1 42162654

This scientific work was supported by a scientific grant from Bayer Schering® laboratory allocated to the Faculté Libre de Médecine de Lille, Catholic University-Lille, France. This grant was mainly used to cover laboratory analysis expenses for urinary and fecal markers.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article. Research support played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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Received: 2011-12-22
Accepted: 2012-04-19
Published Online: 2012-05-11
Published in Print: 2013-02-01

©2013 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm-2012-0083
Keywords for this article
cow’s milk allergy; eosinophil-derived neurotoxin; fecal biomarkers; gut microbiota; intestinal permeability

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  1. Letters to the Editor
  2. Performance evaluation of three different immunoassays for detection of antibodies to hepatitis B core
  3. Serum homocysteine concentrations in Chinese children with autism
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  5. Interference of hemoglobin (Hb) N-Baltimore on measurement of HbA1c using the HA-8160 HPLC method
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  11. Is osteopontin stable in plasma and serum?
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  17. Lessons from controversy: biomarkers evaluation
  18. Commercial immunoassays in biomarkers studies: researchers beware!1)
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  20. Reviews
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  22. Chronic Chagas disease: from basics to laboratory medicine
  23. General Clinical Chemistry and Laboratory Medicine
  24. Shop for quality or quantity? Volumes and costs in clinical laboratories
  25. Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention
  26. Evaluation of high resolution gel β2-transferrin for detection of cerebrospinal fluid leak
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  28. Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission
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