The relationship between salivary, stool and serum periostin, calprotectin and lactoferrin levels and atopy and tolerance development in children with allergic proctocolitis

INTRODUCTION: Allergic proctocolitis (AP), with the full name of food protein-associated allergic proctocolitis, is a non-IgE mediated (T cell mediated) food allergy type. There is no consensus on the frequency, diagnosis, treatment and approach steps of allergic proctocolitis. OBJECTIVE: There is no specific marker for the diagnosis of allergic proctocolitis. It is aimed to find practical, inexpensive and easily applicable markers that can be used in the diagnosis and follow-up of allergic proctocolitis cases. METHODS: In this study, 60 cases (age group 1-7 months) were evaluated. The periostin, calprotectin and lactoferrin values of 30 children diagnosed with allergic proctocolitis were compared with the values of 30 healthy children after salivation, serum and stool after the elimination diet applied during the active period and until tolerance developed. In addition, the relationship between atopy levels and tolerance development time of patients with biomarkers was investigated. In addition, complete blood count, C reactive protein level, stool occult blood, serum total IgE, Fx 5 levels, PT, aPTT, INR and skin test results of the patients and healthy group were evaluated. RESULTS: No significant difference was found in the biomarker values of the patients and the healthy group in the male and female subjects. The mean age of onset of symptoms was 2.8 months (0.7-6) and the mean duration of symptoms was 1.1 months (0.1-5). Nutritional status did not have any effect on symptom onset age and tolerance development (p = 0.722 p = 0.913). One third of the patients had atopic dermatitis. Family history of atopy was seen in 10 (33.3%) of the 30 patients in the patient group, and in 3 (10%) of the 30 patients in the healthy group (p = 0.03). Colic was seen in 18 (60%) of the 30 patients in the patient group, whereas it was found in 9 cases in the healthy group (p=0.01). Eosinophilia was found in patients with allergic proctocolitis (p = 0.010). Fx5 panel positivity was not associated with AP symptom duration at the first control (p = 0.893). Patients with multiple food allergy were not associated with AP symptom duration and family history of atopy (p = 0.103 p = 0.213). The total duration of the diet was 2.2 (1-5) months. During follow-up, all our patients developed tolerance. No correlation was found between the first and second control markers of the patients (p> 0.05). The first control values of the patients in the patient group and the salivary calprotectin values of the healthy control group were significantly higher in the patient group (p = 0.003). Serum and stool periostin levels were found to be higher after tolerance. Sensitivity and specificity of serum periostine 0.967 ng / mL were 50% and 50% in predicting AP. Salivary lactoferrin levels were found to be high in patients with eosinophilia at the first control (p = 0.003). CONCLUSION: During follow-up, all patients developed tolerance. The salivary calprotectin levels of the patients in the patient group were higher than the healthy population. Serum and salivary periostin levels were higher than the healthy group, even after tolerance developed, indicating that chronic inflammation persisted. Serum periostin was found to be useful in predicting the presence of AP above 0.967 ng / mL. Keywords: Allergic proctocolitis, Periostin, Calprotectin, Lactoferrin, Atopy, Tolerance