SUMMARY Forty six children presented with colitis between 1977 and 1981, and all 8 of those below the age of 2 years had food allergic colitis which resolved completely after exclusion of certain foods. In most of the 8 the onset was soon after starting foods other than breast milk. The most common offending food was cows' milk protein, but soya (3 cases) and beef (1 case) were also implicated. A history of allergy in the child or family was common as were blood eosinophilia, high concentrations of serum IgE, and positive IgE antibodies. Colonoscopic appearances were distinctive and biopsies showed a noticeable increase in eosinophils and IgE-containing cells in the lamina propria. We suggest that food allergy is the major cause of colitis in infancy and that an exclusion diet is the treatment of choice.There are two peaks of age incidence in inflammatory bowel disease and the first peak, which occurs in infancy,1 2 may represent a different disease process from that occurring in older children. Food allergy has been implicated in the aetiology of colitis and rectal bleeding,36 and we have therefore studied the effect of dietary treatment in colitis in children who presented below the age of 2 years. Patients and methods
No abstract
SUMMARY 24 children with severe protracted diarrhoea from 10 families, in which at least one sibling was affected, are reported. In two families the siblings were from 1st-cousin marriages, in one family both parents had unaffected children from previous marriages, and in another family the mother had a normal daughter from an earlier marriage. The onset of the diarrhoea was on the first day of life in 12 infants, some time during the first 17 days in 10, and at 13 weeks and 1 year 6 days in the remaining two. In each case the diarrhoea was 'cholera-like'. Investigations failed to show any of the established causes of protracted diarrhoea and 21 (87 5 %) infants died after an illness that had lasted between 12 days and 6 years 38 weeks, despite periods of prolonged intravenous feeding and the administration of a wide variety of pharmacological agents. The 2 patients who recovered appeared to do so spontaneously. 14 (58 %) had associated extra-gastrointestinal or gastrointestinal-related anomalies. Steady-state perfusion studies were performed in the proximal jejunum of 2 patients, and in the colon of one. In both cases the jejunum was in a net secretory state with respect to water, glucose absorption was markedly reduced, and the transmural potential difference was also depressed; in one of these patients fructose absorption was also reduced, and in the other colonic function appeared to be normal. These studies suggest that the diarrhoea resulted from small intestinal secretion overwhelming the reabsorptive capacity of a normally-functioning colon. Although this series of lethal protracted diarrhoea does not represent a single disease entity, the familial pattern suggests an autosomal recessive mode of inheritance for at least one of the conditions.We have previously reported a series of 82 cases of protracted diarrhoea in infancy and briefly described 6 patients in whom diarrhoea dated from the newborn period;1 of these 6 patients, 2 were siblings and 2 others had similarly affected siblings. Four of the 6 patients died, giving a mortality rate for the series of 5 %.We now report 24 cases (including the 4 patients we described earlier), from 10 families in which at least one sibling also had severe protracted diarrhoea. Each patient has presented to one of three hospitals* during the last 14 years, and 22 of them have been reported in abstract form.2 PatientsThe clinical details of the patients and unaffected siblings are shown in Table 1. The siblings in families 2 and 7 were from 1st-cousin marriages, both
A four-year-old girl presented in renal failure due to dihydroxyadenine urolithiasis. Prior to this she had been fed a high purine macrobiotic diet, rich in pulses and grain. She was comatose, anuric, requiring peritoneal dialysis, and bilateral radiolucent renal calculi were revealed by ultrasonography and retrograde pyelography. 2,8-dihydroxyadenine stones were found at pyelolithotomy, renal biopsy revealed interstitial birefringent crystals, and a complete lack of adenine phosphoribosyl transferase (APRT) was found subsequently in erythrocyte lysates. APRT levels were initially falsely raised due to a blood transfusion on admission. The mother was shown to have heterozygote levels. The child was treated successfully with allopurinol, and a reduction in dietary purine but with only partial return of renal function.
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