INTESTINAL INFLAMMATION IN CHILDREN WITH ATOPIC ECZEMA - FECAL EOSINOPHIL CATIONIC PROTEIN AND TUMOR-NECROSIS-FACTOR-ALPHA AS NONINVASIVE INDICATORS OF FOOD ALLERGY

Background Food allergy is contemplated in atopic eczema. Early recogn ition of food allergies is difficult and the diagnosis is often missed because of the non-specificity of symptoms. New non-invasive tests ar e clearly needed. Objective and methods We measured the concentrations of tumour necrosis factor-alpha, eosinophil cationic protein and alph a-1 antitrypsin in faeces as indicators of intestinal inflammation ind uced by double-blind placebo-controlled oral cow's milk challenge in i nfants and young children with atopic eczema. Results An increased alp ha-1 antitrypsin concentration (>2 mg/g) after cow's milk challenge wa s detected in 43% of the infants positive as compared with 11% of the infants negative to challenge, P=0.02. The concentration of eosinophil cationic protein in faeces increased after cow's milk challenge in pa tients positive to challenge (P=0.02) but not in those negative to cha llenge (P=0.79). The concentration of eosinophil cationic protein was enhanced particularly in patients manifesting immediate-type reactions to the cow's milk challenge. The concentration of tumour necrosis fac tor-alpha increased after cow's milk challenge in patients positive to challenge (P=0.005) but not in those negative to challenge (P=0.25). The concentration of tumour necrosis factor-alpha in faeces was enhanc ed particularly in patients manifesting delayed-type reactions to the cow's milk challenge. Conclusion We conclude that in children with ato pic eczema food allergy is associated with intestinal inflammation ind icating that more general immunologic disturbances than previously tho ught take place in these patients. We further suggest that faecal eosi nophil cationic protein, tumour necrosis factor-alpha and alpha-1 anti trypsin distinctly indicate various reaction types of food allergy. Pa rallel testing with eosinophil cationic protein and tumour necrosis fa ctor-alpha may significantly enhance the accuracy in diagnosis of food allergy in patients with atopic eczema.