Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation

BMC Gastroenterology

Salvatore Cucchiara²  Tullio Frediani¹  Simone Frediani²  Tatiana Federici²  Adriana Marcheggiano³  Ylenia D'Alfonso²  Ginevra Lastrucci²  Giovanni Di Nardo²  Sandra Lucarelli² 

[1] Pediatric Allergology Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy;Pediatric Gastroenterology Endoscopy and Liver Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy;Department of Clinical Sciences, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy

关键词: patch test;    breast feeding;    food allergy;    allergic proctocolitis;   

Others  :  1113298
DOI  :  10.1186/1471-230X-11-82

 received in 2011-01-06, accepted in 2011-07-16,  发布年份 2011

【 摘 要 】

Background

Allergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. In most cases a maternal cow milk-free diet leads to a prompt resolution of rectal bleeding, while in some patients a multiple food allergy can occur. The aim of this study was to assess whether the atopy patch test (APT) could be helpful to identify this subgroup of patients requiring to discontinue breast-feeding due to polisensitization. Additionally, we assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. amino acid-based formula

Methods

We have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. The diagnosis was confirmed by endoscopy with biopsies. Skin prick tests and serum specific IgE for common foods, together with APTs for common foods plus breast milk, were performed. After a 1 month therapy of an AAF all patients underwent a follow-up rectosigmoidoscopy.

Results

Prick tests and serum specific IgE were negative. APTs were positive in 100% infants, with a multiple positivity in 50%. Sensitization was found for breast milk in 100%, cow's milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants.

Conclusions

These data suggest that APT might become a useful tool to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism, with the aim to avoid unnecessary maternal dietary restrictions before discontinuing breast-feeding.

【 授权许可】

   
2011 Lucarelli et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Lake AM: Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr 2000, 30:558-60.
• [2]Maloney J, Nowak-Wegrzyn A: Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastro enteritis with protein-losing gastroenteropathy as manifestations of non IgE-mediated cow's milk allergy. Pediatr Allergy Immunol 2007, 18:360-7.
• [3]Pumberger W, Pomberger G, Geissler W: Proctocolitis in breast-fed infants: a contibution to differential diagnosis of haematochezia in early childhood. Postgrade Med J 2001, 77:252-4.
• [4]Xanthakos SA, Schwimmer JB, Melin-Aldana H, et al.: Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study. J Pediatr Gastroenterol Nutr 2005, 41:16-22.
• [5]Dupont C, Heyman M: Food protein-induced enterocolitis syndrome: Laboratory perspective. J Pediatr Gastroenterol Nutr 2000, 30:S50-7.
• [6]Odze RD, Wershil BK, Leichtner AM, Antonioli DA: Allergic colitis in infants. J Pediatr 1995, 126:163-70.
• [7]Sampson HA: Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001, 107:891-896.
• [8]Verstege A, Mehl A, Rolinc-Werninghaus C, et al.: The predictive value of the skin prick test weal size for the outcome food challenges. Clin Exp Allergy 2005, 35:1220-6.
• [9]Spergel JM, Brown-Whitehorn T: The use of patch testing in the diagnosis of food allergy. Curr All Asthma Rep 2005, 5:86-90.
• [10]Kenscherlohr K, Darsow U, Burgdorf WHC, et al.: Lessons from atopy patch testing in atopic dermatitis. Curr All Asthma Rep 2004, 4:285-289.
• [11]Darsow U, Ring J: Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin and Experiment Dermatol 2000, 25:544-551.
• [12]Martino F, Bruno G, Aprigliano D, et al.: Effectiveness of a home-made meat based formula (the Rezza-Cardi diet) as a diagnostic tool in childre with food-induced atopic dermatitis. Pediatr Allergy Immunol 1998, 9:192-196.
• [13]Iacono G, Ravelli A, Di Prima L, et al.: Colonic lymphoid nodular hyperplasia in children:relationship to food hypersensitivity. Clin Gastroenterol Hepatol 2007, 5:361-6.
• [14]Wilson NW, Self TW, Hamburger RW: Severe cow's milk induced colitis in an exclusively breast-fed neonate. Clin Pediatr 1990, 29:77-80.
• [15]Kumar D, Repucci A, Wyatt-Ashmead J, et al.: Allergic colitis presenting in the first day of life: Report of three cases. J Pediatr Gastroenterol Nutr 2000, 31:195-197.
• [16]Sorea S, Dabadie A, Bridoux-Henno L, et al.: Hemorrhagic proctocolitis in exclusively breast-fed children. Archives de Pédiatrie 2003, 10:772-775.
• [17]Sierra Salinas C, Alonso Blasco J, Olivares Sànchez L, et al.: Allergic colitis in exclusively breast-fed infants. Ann Pediatr (Barc) 2006, 64:158-161.
• [18]Arvola T, Ruuska T, Keranen J, et al.: Rectal bleeding in infancy: clinical, allergological and microbiological examination. Pediatrics 2006, 117:760-8.
• [19]Shannon WR: Demonstration of food proteins in human breast milk by anaphilactic experiments in guinea pigs. Am J Dis Child 1921, 22:223-5.
• [20]American Academy of Pediatrics Committee on Nutrition: Hypoallergenic infant formulas. Pediatrics 2000, 106:346-349.
• [21]De Boisseau D, Matarazzo P, Dupont C: Allergy to extensively hydrolyzed cow milk proteins in infants: idantification and treatment with an amino acid-based formula. J Pediatr 1997, 131:744-747.
• [22]Isolauri E, Sutas Y, Makinen KS, et al.: Efficacy and safety of hydrolyzed cow milk and amino acid-derived formulas in infants with cow milk allergy. J Pediatr 1995, 127:550-557.
• [23]Vanderhoof JA, Murray ND, Kaufman SS, et al.: Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants. J Pediatr 1997, 131:741-744.
• [24]Sicherer SH, Noone SA, Koerner CB, et al.: Hypoallergenicity and efficacy of an amino acid-based formula in children with cow's milk and multiple food hypersensitivities. J Pediatr 2001, 138:688-693.
• [25]Turunen S, Karttunen TJ, Kokkonen J: Lymphoid nodular hyperplasia and cow's milk hypersensitivity in children with chronic constipation. J Pediatr 2004, 145:606-11.
• [26]Troncone R, Discepolo V: Colon in food allergy. J Pediatr Gastroenterol Nutr 2009, 48:S89-91.
• [27]Isolauri E, Turjanmaa K: Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis. J Allergy Clin Immunol 1996, 1:9-15.
• [28]Niggemann B, Reibel S, Wahn U: The atopy patch test (APT) - a useful tool for the diagnosis of food allergy in children with atopic dermatitis. Allergy 2000, 55:281-285.
• [29]Roehr CC, Reibel S, Ziegert M, et al.: Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol 2001, 107:548-553.
• [30]Heine G: Gastroesophageal reflux disease, colic and constipation in infants with food allergy. Curr Opin Clin Immunol 2006, 6:220-225.
• [31]Cudowska B, Kaczmarski M: Atopy patch test in the diagnosisi of food allergy in children with gastrointestinal symptoms. Adv Med Sci 2010, 55:153-160.
• [32]Spergel JM, Beausoleil JL, Mascarenhas M, et al.: The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002, 109:363-368.
• [33]Fogg MI, Brown-Whitehorn TA, Pawloski NA, et al.: Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol 2006, 17:351-355.
• [34]Wistokat-Wülfing A, Schmidt P, Darsow U, et al.: Atopy patch test reactions are associated with T-lymphocyte-mediated allergen-specific immune responses in atopic dermatitis. Clin Exp Allergy 1999, 29:513-521.
• [35]Dargent JL, Souayah H, Hainaut M: Granulomatous variant of allergic proctocolitis. Hystopathology 2009, 55:758-60.
• [36]Boné J, Claver A, Guallar I, Plaza AM: Allergic proctocolitis, food-induced enterocolitis: immune mechanism, diagnosis and treatment. Allergol Immunopathol 2009, 37:36-42.