Intestinal permeability in children: variation with age and reliability in the diagnosis of cow's milk allergy

Abstract

Kalach N, Rocchiccioli F, de Boissieu D, Benhamou PH, Dupont C. Intestinal permeability in children: variation with age and reliability in the diagnosis of cow's milk allergy. Acta Paediatr 2001; 90: 499-504. Stockholm. ISSN 0803-5253 Objective: To analyse to what extent age may alter intestinal permeability (IP) in children and to assess its reliability according to clinical manifestations in cow's milk allergy (CMA). Design: A routine prospective study was performed in 200 children (12.5 § 23 mo, 0.5-168 mo) presenting with clinical manifestations suggesting CMA. Controls (n = 105) were those with a negative cow's milk challenge, whereas CMA children (n = 95) ful lled ESPGHAN criteria. Permeability was measured as a percentage of urinary excretion of lactitol (L, %) and mannitol (M, %) (0.1 g/kg for each, oral absorption after a 6 h fast, 5 h urine collection, analysis by gas chromatography) and determination of the L/M ratio (L/M, %). Results: In control children, L/M correlated negatively with age (r ¡0.33, p = 0.0006), whereas in those with CMA no correlation was found. Median L/M was signi cantly higher in CMA children (n = 95) than in controls (n = 105), 4.35 § 7.57% (95% CI 5.30-8.39%) vs 1.97 § 0.87% (95% CI 1.76-2.09%), (p = 0.0001). With a L/M cut-off value de ned as mean ‡ 2 SD of controls, in CMA IP exhibited a 68% sensitivity and a 77% negative predictive value. The highest sensitivity (70%) was seen at ages 6-12 mo and the lowest (58%) at age more than 3 y. An abnormal IP was seen in 80% of CMA children with digestive manifestations, in 43% with extra-digestive, 68% with mixed and 40% with anaphylactic manifestations.Conclusion: IP correlates negatively with age in control children and is altered in children with CMA. The test is at its most accurate in the diagnosis of CMA when done at ages 6-12 mo, when there are digestive manifestations.

Breastmilk cell trafficking induces microchimerism‐mediated immune system maturation in the infant

“…16,17 While gut permeability drops rapidly during the first days of life, a very gradual process of gut closure is observed over the first few years of life. 18,19 It is currently unknown whether this second phase of prolonged, but diminished gut permeability has a significant physiologic role. Studies measuring intestinal permeability by lactulose/mannitol ratio have shown prolonged intestinal permeability in formula-fed infants compared to breastfed infants during the first 2 weeks, 14,20 with similar gut permeability observed at 1 month.…”

Induction of immune tolerance to caseins and whey proteins by oral intubation in mouse allergy model

“…Clinical features due to IgE-mediated reactions are expressed as immediate symptoms mostly. Clinical symptoms may involve the skin, respiratory tract and gastrointestinal tract and can even lead to a systemic anaphylactic reaction (Kalach et al, 2001;Furrie, 2005).…”

Effect of hyperbilirubinemia on intestinal permeability in healthy term newborns

“…In the present study, we demonstrated to the best of our knowledge, for the first time, the effect of bilirubin on the intestinal barrier of healthy term newborns before phototherapy. SAT is widely considered a reliable nontoxic, noninvasive and simple to perform test to study the intestinal barrier (10). Lactulose permeates the intestinal barrier by the paracellular route through paracellular junctions while mannitol uptake occurs preferentially through the transcellular route (11).…”

“…Moreover, UCB may alter lipid polarity and fluidity, protein order and redox status (20) thus impairing the transcellular diffusion of mannitol. This explanation, however, may be too naive as no significant intestinal epithelial injury or decreased absorptive capacity has ever been shown in animal (or in vitro) studies in Gunn rats (9,10). Moreover, the evidence of an exclusively transcellular permeation of monosaccharides is still controversial.…”