Intestinal permeability in patients with atopic eczema

Abstract

Intestinal permeability was investigated in adult patients with atopic eczema by in vivo and in vitro techniques. Patients with symptoms of 'immediate' food allergy were specifically excluded. A 51Cr-labelled ethylenediaminetetraacetate absorption test was carried out in eighteen patients. Their mean (+/- s.d.) 24-hour urine excretion following oral administration of the test substance (2.1 +/- 0.9%) did not differ significantly from that of thirty-four normal controls (1.9 +/- 0.5%). Small bowel permeability was estimated directly in jejunal mucosal samples in ten patients with three permeability probes of differing molecular weight. Mucosal permeability did not differ significantly from that of fifteen control patients for any of the test substances. Two patients had abnormal results by both tests and in one this was due to coeliac disease. These results suggest that altered intestinal permeability is not important in the pathogenesis of eczema. Patients demonstrating increased intestinal permeability should undergo jejunal biopsy to exclude significant small bowel disease.

IgG Subclass of Human Serum Antibodies Reactive with Dietary Proteins

“…In contrast, recent evidence [18] now favours a lack of any major defect in intestinal permeability in AE (and presumably normal individuals). In the absence of a mucosal defect, gastro-intestinal presentation of protein antigens fails to induce IgG antibody and may suppress IgE antibody formation [19], Interest ingly, none of the lgG4 anti-gliadin antibody-positive sera from normal individuals had either raised IgE levels or IgE anti-wheat antibodies [6].…”

Intestinal Permeability: Clinical Correlates

“…5lCr-EDTA absorption was normal in all but 2 of 18 patients with eczema [27], One of these had unsuspected coeliac disease and the other mild jejunal abnormalities. Subsequent studies in food allergy have not shown any consistent abnormalities with 5lCr-EDTA.…”

“…It is nev ertheless conceivable that colonic absorption is somewhat increased in patients with secre tory diarrhoea due to small bowel disease. It has, however, been particularly reassuring that altered intestinal permeability in a vari ety of diseases, as seen by the 5lCr-EDTA permeability test, have been confirmed by an in vitro technique which assesses directly je junal permeability [24,26,27], The second point is that 51Cr-EDTA is administered in trace amounts (<0.6 pmol) which does not interfere with normal intestinal physiology. The sugars, however, are given in quantities which cause osmotic retention of water within the lumen, causing intestinal hurry and therefore in part bypassing the area of interest.…”

Small intestinal permeability in patients with eosinophilic oesophagitis during active phase and remission

“…In small intestinal diseases, such as coeliac disease, there is a defect in tight junction regulator zonulin 9 that leads to dilated intercellular spaces. Increased small bowel permeability has been reported in other allergic diseases such as nasal polyposis 11 and eczema 12. In these conditions, and in many conditions associated with increased small bowel permeability, such as in irritable bowel syndrome,13–15 the small bowel mucosa is histologically normal although increased permeability to probe molecules, or tight junction dysregulation or dysfunction has been reported (reviewed in ref 14).…”