Food allergy and intolerance: response to intestinal provocation monitored by endosonography.
OBJECTIVE
Objective assessment of adverse reactions to food is a long-felt want. We report our preliminary experience with a new endosonographic allergen provocation test.


METHODS
Twenty patients were examined, seven patients having food allergy and 13 having food intolerance. The duodenal mucosa was challenged with allergen extracts via a nasoduodenal tube. The responses were recorded using a miniprobe for endosonography through the tube. Thereafter, intestinal lavage was performed by giving 2 l PEG solution containing micro Ci (51)CrEDTA. The gut lavage fluid and urine for 5 h were collected.


RESULTS
Increased mucosal thickness in response to provocation was recorded in 11 patients, but not more often or pronounced in the allergic than in the intolerance group. Interestingly, increased mucosal thickness associated with a new echogenic layer was seen in two patients and a sustained duodenal contraction, lasting 15-20 min associated with pain, in another two. Intestinal permeability and inflammatory mediators were not significantly different in the two groups.


CONCLUSIONS
In patients with self-reported adverse reactions to food abnormal responses to duodenal provocation may be recognised by endosonography. However, neither endosonography nor intestinal permeability or faecal calprotectin responses were able to distinguish between food allergy and intolerance. Sustained duodenal contractions in response to food might be a cause of abdominal pain.
Arslan
Gülen
G
gulen.Medical Department, Division of Gastroenterology, Institute of Medicine, Haukeland University Hospital, University of Bergen, N-5021, Bergen, Norway. gulen.arslan@med.uib.no
Ødegaard
Svein
S
Elsayed
Said
S
Florvaag
Erik
E
Berstad
Arnold
A
D000485:Allergens; D004386:Duodenum / Q000000981:diagnostic imaging / Q000276:immunology; D019160:Endosonography; D005512:Food Hypersensitivity / Q000000981:diagnostic imaging*; D005517:Foodborne Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000276:immunology; D012882:Skin Tests
D000485:Allergens