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Published on: February 11, 2021
Intestinal permeability in children: variation with age and reliability in the diagnosis of cow's milk allergy
N Kalach1, F Rocchiccioli, D de Boissieu
1Department of Pediatrics, Hĵpital Cochin St Vincent de Paul, Paris, France. christophe.dupont@svp.ap-hop-paris.fr
Insights
Intestinal permeability (IP) increases with age in healthy children but is elevated in cow's milk allergy (CMA). Diagnostic accuracy for CMA is highest between 6-12 months, especially with digestive symptoms.
Area of Science:
- Pediatric Gastroenterology
- Allergy Immunology
- Clinical Nutrition
Background:
- Intestinal permeability (IP) is a crucial factor in gut health and immune response.
- Cow's milk allergy (CMA) is a common condition in infants and children, often associated with gastrointestinal symptoms.
- Understanding how age affects IP and its diagnostic utility in CMA is important for accurate clinical management.
Purpose of the Study:
- To investigate the relationship between age and intestinal permeability in children.
- To evaluate the diagnostic reliability of IP measurements in children with suspected cow's milk allergy (CMA).
- To assess the correlation between IP and clinical manifestations in CMA.
Main Methods:
- A prospective study involving 200 children (0.5-168 months) with suspected CMA.
- Intestinal permeability assessed using lactulose (L) and mannitol (M) urinary excretion (L/M ratio).
- Comparison between 95 children with confirmed CMA and 105 healthy controls.
Main Results:
- A negative correlation between L/M ratio and age was observed in control children (p=0.0006).
- Children with CMA exhibited significantly higher L/M ratios compared to controls (p=0.0001).
- IP testing showed 68% sensitivity and 77% negative predictive value for CMA, with highest accuracy at 6-12 months and in children with digestive symptoms.
Conclusions:
- Intestinal permeability is inversely related to age in healthy children and is significantly altered in children with CMA.
- IP measurement is a valuable diagnostic tool for CMA, particularly in infants aged 6-12 months.
- The presence of digestive manifestations in CMA enhances the diagnostic accuracy of IP testing.
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) fulfilled 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 significantly 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 defined 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.
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