RESEARCH - Cow's milk protein sensitivity is related to IBS in primary Sjogren's syndrome

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Clin Exp Allergy. 2008 June; 38(6): 929–935.

doi: 10.1111/j.1365-2222.2008.02983.x. PMCID: PMC2440347

Cow's milk protein sensitivity assessed by the mucosal patch technique

is related to irritable bowel syndrome in patients with primary

Sjögren's syndrome

M Lidén,* G Kristjánsson,†1 S Valtysdottir,* P Venge,‡ and R Hällgren*

*Clinic of Rheumatology, Department of Medical Sciences, University

Hospital, Uppsala, Sweden

†Section of Gastroenterology, Department of Medical Sciences,

University Hospital, Uppsala, Sweden

‡Laboratory for Inflammation Research, Department of Medical Sciences,

University Hospital, Uppsala, Sweden

Introduction

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.

Conclusion

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.

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