Fecal Assays Detect Hypersensitivity to Cow's Milk Protein and Gluten in Adults With Irritable Bowel Syndrome
Open accessAbstract
Background & aims Some patients with irritable bowel syndrome (IBS)-like symptoms suffer from food hypersensitivity (FH); their symptoms improve when they are placed on elimination diets. No assays identify patients with FH with satisfactory levels of sensitivity. We determined the frequency of FH among patients with symptoms of IBS and the ability of fecal assays for tryptase, eosinophil cationic protein (ECP), or calprotectin to diagnose FH.Methods The study included 160 patients with IBS, 40 patients with other gastrointestinal diseases, and 50 healthy individuals (controls). At the start of the study, patients completed a symptom severity questionnaire, fecal samples were assayed, and levels of specific immunoglobulin E were measured. Patients were observed for 4 weeks, placed on an elimination diet (without cow's milk and derivatives, wheat, egg, tomato, and chocolate) for 4 weeks, and kept a diet diary. Those who reported improvements after the elimination diet period were then diagnosed with FH, based on the results of a double-blind, placebo-controlled, oral food challenge (with cow's milk proteins and then with wheat proteins).Results Forty of the patients with IBS (25%) were found to have FH. Levels of fecal ECP and tryptase were significantly higher among patients with IBS and FH than those without FH. The ECP assay was the most accurate assay for diagnosis of FH, showing 65% sensitivity and 91% specificity.Conclusions Twenty-five percent of patients with IBS have FH. These patients had increased levels of fecal ECP and tryptase, indicating that they might cause inflammation in patients with IBS. Fecal assays for ECP could be used to identify FH in patients with IBS.
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Few studies demonstrated increased peripheral blood basophil activation following stimulation with food antigens and elevated levels of fecal tryptase and eosinophil cationic protein in patients with IBS and food hypersensitivity.
“In addition, few studies demonstrated increased peripheral blood basophil activation following stimulation with food antigens (30) and elevated levels of fecal tryptase and eosinophil cationic protein (31) in patients with IBS and food hypersensitivity, thus further suggesting possible inflammatory and altered immune etiology.”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [31]
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- Authors
- Carroccio, A., Brusca, I., Mansueto, P., Soresi, M., D'Alcamo, A., Ambrosiano, G., Pepe, I., Iacono, G., Lospalluti, M. L., La Chiusa, S. M., & di Fede, G.
- Affiliations
- University of Palermo (IT)
- Ospedale Buccheri la Ferla Fatebenefratelli (IT)
- Corresponding author
- Carroccio, Antonio
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 9
- Issue
- 11
- Pages
- 965-971.e3
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W1996297732
- Cited by
- 75
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 7 · 2016: 6 · 2015: 10 · 2014: 6 · 2013: 13 · 2012: 5
- FWCI
- 5.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Keywords
- irritable bowel syndrome, food allergy, cow's milk protein, gluten, wheat, eosinophil cationic protein, tryptase, calprotectin, fecal biomarkers, elimination diet, oral food challenge, specific immunoglobulin E, diagnostic accuracy
- MeSH terms
- Adolescent, Adult, Diet, Double-Blind Method, Feces, Female, Glutens, Humans, Male, Middle Aged, Placebos, Milk Hypersensitivity, Wheat Hypersensitivity, Leukocyte L1 Antigen Complex, Irritable Bowel Syndrome, Eosinophil Cationic Protein, Tryptases, Young Adult
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