food allergy finding - Kokkonen et al 2004

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An important finding merely because a food allergy subgroup is accepted as

reality.

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" ...up to half the children with prolonged GI symptoms have immune

mediated disorder; CD and food allergy being the most obvious clinical

entities. "

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1: Acta Paediatr. 2004 Dec;93(12):1601-7.

Enhanced local immune response in children with prolonged gastrointestinal

symptoms.

Kokkonen J, Holm K, Karttunen TJ, Maki M.

Department of Paediatrics, University of Oulu, Oulu, Finland.

jorma.kokkonen@...

AIM: Recently, we reported typical endoscopic findings and an

increment in gammadelta+ T cells in the foregut among children with

food-sensitive enteropathy other than coeliac disease. To find out the

extend to which the upregulation of the local immune response might

explain gastrointestinal (GI) complaints of the foregut, we sought to

examine by the increment in gammadelta+ T cells a I-y consecutive

series of children referred for recurrent GI complaints to a

tertiary-level hospital. METHODS: A 1-y cohort of 102 children

scheduled for gastroduodenoscopy were examined for mucosal histology

and the densities of CD3+, alphabeta+ and alphabeta+ T-cell subsets

from mid-duodenal specimens. The final diagnostic categories were used

in analysing the data. RESULTS: Fifteen subjects showed villous

atrophy and a high gammadelta+ T-cell density; the finding being

compatible with coeliac disease (CD). At the other extreme, 20

subjects in whom diagnostic GI diseases were ruled out showed low

densities and served as controls. The subjects reporting GI symptoms

after an open food challenge with milk and/or cereals (n = 18) as well

as children remitting with a milk- or cereal-eliminating diet but not

responding to a challenge (n = 23) also expressed significantly higher

densities of gammadelta+ T cells than the controls. In all, 45 of 102

children could be considered to have an elevated gamma6+ T-cell

density as an indication of locally activated immune response. Lack of

villous architecture and lymphonodular hyperplasia of the duodenal

bulb as an endoscopic finding and atopic dermatitis but not the

presence of DQ2 alleles showed a close association with these

increased densities. CONCLUSION: Considering that an elevated

incidence of gammadelta+ T cells is an indication of mucosal response

against luminal antigens, up to half the children with prolonged GI

symptoms have immune mediated disorder; CD and food allergy being the

most obvious clinical entities.

PMID: 15841768