Possibilities of diagnosing gastrointestinal food allergy in children at the modern stage

Nowadays, the issues of diagnosing various adverse reactions to food in different periods of childhood remain quite relevant. The variety of food allergens that people eat, the presence of chronic diseases of the gastrointestinal tract and other pathological conditions, the unpredictability of the allergic response when eating food ingredients and the deterioration in quality of life due to the unreasonable elimination of certain foods determine the direction of further research into food allergy‑related problems. Objective — to investigate the predictive range of risk factors for the development of gastrointestinal food allergy with the subsequent development of a diagnostic and prognostic algorithm and optimisation of its early diagnosis in children of different ages. Materials and methods. To achieve this objective and determine the diagnostic coefficients (DC) of individual prognostic signs, more than 40 clinical and laboratory parameters and anamnestic data of 54 children were studied (28 children with morphologically confirmed gastrointestinal allergy, who represented the main group of the study and 26 patients with gastrointestinal pathology of non‑allergic origin (69.2% of functional and 30.8% of organic origin), who were included in the comparison group). In‑depth comprehensive examination included general clinical examinations, endoscopic and histological examinations and determination of immunological markers (interleukin‑4, interleukin‑10 and chemokine TARC/CCL‑17). To develop adiagnostic and prognostic algorithm, we performed statistical calculations using the method of alternative sequential Wald analysis, which, by summing conditional values that characterise the informativeness of individual indicators, provides specific information for obtaining an individual prognosis. Results. The sex distribution of the examined children was almost uniform with a predominance of boys in both groups (67.9% and 61.5%, respectively; p=0.841). The manifestations of food allergies were significantly more common in young children (39.3% in the main group vs. 11.5% in the comparison group; p=0.44; DC=+5.3) and was one of the first steps in the evolution of the atopic march. The analysis of the DCs of the main predictors of gastrointestinal food allergy in children makes it possible to form a generalised diagnostic algorithm taking into account the most informative positive and negative prognostic risk factors. Given the high degree of correlation between anamnesis, clinical symptoms, immunological markers and the development of gastrointestinal allergy, the proposed prognostic model makes it possible to form a risk group for the development of this pathology among children and adolescents who have gastrointestinal symptoms after eating a meal or a certain food product and to differentiate true (immune) reactions of food hypersensitivity from non‑immune reactions of food intolerance, which can model the clinical picture of non‑allergic gastrointestinal lesions. In patients who score more than 60 points (high risk), the development of gastrointestinal allergy can be predicted with a probability of up to 95%. Conclusions. As a result of a comprehensive examination of children with gastrointestinal symptoms associated with the intake of food or certain food products, the main predictors of gastrointestinal food allergy were identified. Their generalisation and systematisation made it possible to use the most significant of them as key markers to create a prognostic algorithm for the risk of developing gastrointestinal allergy.