Abstract
Background: The diagnosis of food hypersensitivity (FH) in adult patients with gastrointestinal symptoms, beyond the immediate IgE-mediated clinical manifestations, is very often difficult. The aims of our study were to: 1) evaluate the frequency of FH in patients with irritable bowel syndrome (IBS)-like clinical presentation; and 2) compare the diagnostic accuracy of two different methods of in vitro basophil activation tests.
Methods: Three hundred and five patients (235 females, age range 18–66 years) were included and underwent a diagnostic elimination diet and successive double-blind placebo-controlled (DBPC) challenges. Two different methods of in vitro basophil activation tests (BAT) (CD63 expression after in vitro wheat or cow’s milk proteins stimulation) were evaluated: one was performed on separated leukocytes, and the other on whole blood.
Results: Ninety patients of the 305 studied (29.5%) were positive to the challenges and were diagnosed as suffering from FH. BAT on separate leukocytes showed a sensitivity of 86% and a specificity of 91% in FH diagnosis. BAT on whole blood showed a sensitivity of 15%–20% and a specificity of 73% in FH diagnosis (p<0.0001 compared to the other method).
Conclusions: About one third of the IBS patients included in the study were suffering from FH and were cured on the elimination diet. The BAT based on CD63 detection on whole blood samples did not work in FH diagnosis and showed a significantly lower sensitivity, specificity and diagnostic accuracy than the assay based on separated leukocytes.
References
1. Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J All Clin Immunol 2010;126:S1–58.10.1016/j.jaci.2010.10.007Search in Google Scholar PubMed PubMed Central
2. Bischoff S, Crowe SE. Gastrointestinal food allergy: new insights into pathophysiology and clinical perspectives. Gastroenterology 2005;128:1089–113.10.1053/j.gastro.2004.08.015Search in Google Scholar PubMed
3. Sampson HA, Sicherer SH, Birnbaum AH. AGA technical review on the evaluation of food allergy in gastrointestinal disorders. American Gastroenterological Association. Gastroenterology 2001;120:1026–40.10.1053/gast.2001.23031Search in Google Scholar PubMed
4. Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184–90.10.1111/j.1572-0241.1998.00531.xSearch in Google Scholar PubMed
5. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut 2004;53:1459–64.10.1136/gut.2003.037697Search in Google Scholar PubMed PubMed Central
6. Carroccio A, Brusca I, Mansueto P, Soresi M, D’Alcamo A, Ambrosiano G, et al. Fecal assays detect hypersensitivity to cow’s milk protein and gluten in adults with irritable bowel syndrome. Clin Gastroenterol Hepatol 2011;9:965–70.10.1016/j.cgh.2011.07.030Search in Google Scholar PubMed
7. Carroccio A, Brusca I, Mansueto P, Pirrone G, Barrale M, Di Prima L, et al. A cytological assay for diagnosis of food hypersensitivity in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2010;8:254–60.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000277421200011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016/j.cgh.2009.11.010Search in Google Scholar PubMed
8. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999;45(Suppl 2):43–7.10.1136/gut.45.2008.ii43Search in Google Scholar PubMed PubMed Central
9. Iacono G, Ravelli A, Di Prima L, Scalici C, Bolognini S, Chiappa S, et al. Colonic lymphoid nodular hyperplasia in children: relationship to food hypersensitivity. Clin Gastroenterol Hepatol 2007;5:361–6.10.1016/j.cgh.2006.12.010http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000245400600018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed
10. Carroccio A, Mansueto P, Iacono G, Soresi M, D’Alcamo A, Cavataio F, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012 Jul 24. DOI: 10.1038/ajg.2012.236.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000312185100019&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1038/ajg.2012.236Search in Google Scholar PubMed
11. Bruns DE, Huth EJ, Magid E, Young DS. Toward a checklist for the reporting of studies of diagnostic accuracy of medical tests. Clin Chem 2000;46:893–5.10.1093/clinchem/46.7.893Search in Google Scholar PubMed
12. Feinstein A. On the sensitivity, specificity and discrimination of diagnostic tests. Clin Pharmacol Ther 1975;17:104–10.10.1002/cpt1975171104Search in Google Scholar PubMed
13. Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: the no man’s land of gluten sensitivity. Am J Gastroenterol 2009;104:1587–94.10.1038/ajg.2009.188Search in Google Scholar PubMed PubMed Central
14. Iacono G, Cavataio F, Montalto G, Florena A, Soresi M, Tumminello M, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med 1998;338:1100–4.10.1056/NEJM199810153391602Search in Google Scholar PubMed
15. De Weck AL, Sanz ML, Gamboa PM, Aberer W, Bienvenu J, Blanca M, et al. Diagnostic tests based on human basophils: more potentials and perspectives than pitfalls. II. Technical issues. J Investig Allergol Clin Immunol 2008;18:143–55.Search in Google Scholar
16. Volta U, Tovoli F, Cigola R, Parisi C, Fabbri A, Piscaglia M, et al. Serological tests in gluten-sensitivity. J Clin Gastroenterol 2012;46:680–5.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000307936900013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1097/MCG.0b013e3182372541Search in Google Scholar PubMed
17. Hennersdorf F, Florian S, Jakob A, Baumgartner K, Sonneck K, Nordheim A, et al. Identification of CD13, CD107a, and CD164 as novel basophil-activation markers and dissection of two response patterns in time kinetics of IgE-depandent upregulation. Cell Res 2005;15:325–35.10.1038/sj.cr.7290301Search in Google Scholar PubMed
18. De Weck AL, Gamboa P, Sanz ML. Comparison of two commercial basophil activation cytofluorometric tests for the diagnosis of allergies and pseudoallergies. EAACI Paris 2003;369–70 [abstract 1299].Search in Google Scholar
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