Available online 29 March 2023

Intestinal epithelial integrity compromise has been identified in gastrointestinal (GI), atopic, and autoimmune diseases.

Episodes of idiopathic anaphylaxis (IA) are often accompanied by GI manifestations. We therefore sought to determine whether surrogate markers of GI permeability were aberrant in this patient population.

Serum concentrations of zonulin, intestinal fatty acid binding protein (I-FABP), and soluble CD14 (sCD14) measured in 54 patients with IA were compared to concentrations in healthy controls (HCs); and correlated with clinical and laboratory parameters.

I-FABP was elevated in sera of patients with IA compared to HCs (median 1378.0 pg/mL vs 479.0 pg/mL respectively, p < 0.001). sCD14 was also elevated compared to HCs (median 2017.0 ng/mL and 1189.0 ng/mL respectively, p <0.001), whereas zonulin was comparable between patients with IA and HCs (median 49.6 ng/mL vs 52.4 ng/mL respectively, p = 0.40). I-FABP was elevated in patients with IA who experienced vomiting and/or diarrhea compared to patients with IA who did not (p = 0.0091).

I-FABP and sCD14 are elevated in the serum of patients with IA. Elevations in these biomarkers of IA provides evidence that increased gastrointestinal permeability, as is observed in other allergic conditions such as food allergy, is a common finding in those with IA and offers possible insight into the pathogenesis of this disease.

© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology