title: Cow's milk protein sensitivity assessed by the mucosal patch technique is related to irritable bowel syndrome in patients with primary Sjögren's syndrome.
abstract: BACKGROUND
  Patients with primary Sjögren's syndrome (pSS) are reported to have a variety of gastrointestinal symptoms partly attributed to an overrepresentation of celiac disease. We have observed that irritable bowel syndrome (IBS)-like symptoms are frequent complaints in this patient group. Allergic manifestations to various drugs are also common in pSS. A role of food allergy in IBS has been proposed.
  
  
  OBJECTIVE
  This study is aimed at evaluating the mucosal response to rectal challenge with cow's milk protein (CM) in patients with pSS and relates possible CM reactivity to their intestinal symptoms.
  
  
  METHODS
  A rectal challenge with CM was performed in 21 patients with pSS and 18 healthy controls. Fifteen hours after challenge the mucosal production of nitric oxide (NO) and the release of myeloperoxidase (MPO) as signs of mucosal inflammatory reaction were measured using the mucosal patch technique.
  
  
  RESULTS
  Eight out of 21 patients with pSS had a definite increase of mucosal NO synthesis and the luminal release of MPO after rectal CM challenge. This sign of milk sensitivity was not linked to IgG/IgA antibodies to milk proteins. The symptoms for IBS according to Rome III criteria were fulfilled in 13 patients. All patients who were CM sensitive suffered from IBS. In a small open study, patients reactive to CM reported an improvement of intestinal symptoms on a CM-free diet.
  
  
  CONCLUSIONS
  A rectal mucosal inflammatory response after CM challenge is seen in 38% of patients with pSS as a sign of CM sensitivity. IBS-like symptoms were common in pSS, linked to CM sensitivity.
authors.affiliation: Clinic of Rheumatology, Department of Medical Sciences, University Hospital, Uppsala, Sweden. maria.liden@medsci.uu.se
authors.forename: M
authors.initials: M
authors.lastname: Lidén
authors.forename: G
authors.initials: G
authors.lastname: Kristjánsson
authors.forename: S
authors.initials: S
authors.lastname: Valtysdottir
authors.forename: P
authors.initials: P
authors.lastname: Venge
authors.forename: R
authors.initials: R
authors.lastname: Hällgren
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D002417:Cattle; D005260:Female; D006683:HLA-DQ Antigens / Q000032:analysis; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D043183:Irritable Bowel Syndrome / Q000150:complications* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016269:Milk Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D008894:Milk Proteins / Q000009:adverse effects*; D009092:Mucous Membrane / Q000276:immunology / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism; D010328:Patch Tests / Q000379:methods; D009195:Peroxidase / Q000378:metabolism; D012007:Rectum / Q000276:immunology / Q000378:metabolism; D012859:Sjogren's Syndrome / Q000150:complications* / Q000276:immunology; D018709:Statistics, Nonparametric
chemical_list: D006683:HLA-DQ Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D008894:Milk Proteins; D009569:Nitric Oxide; D009195:Peroxidase