Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports

Abstract

Allergic colitis is a clinical manifestation of food allergy during the first months of life. It is estimated that genetic factors play a role in the expression of this allergic disease. This case report described the clinical progress of infants who were cousins from two distinct family groups with allergic colitis. Five infants under six months of age and of both sexes were studied, with a diagnosis of allergic colitis characterized clinically and histologically by (1) rectal bleeding; (2) exclusion of infectious causes of colitis; (3) disappearance of symptoms after elimination of cow's milk and dairy products from the child's and/or the mother's diet. Patients were submitted to the following diagnostic investigation: complete blood count; stool culture; parasitologic examination of stools; rectoscopy or colonoscopy; and rectal biopsy. Patient age varied from 40 days to six months; three were males. All patients presented with complaints of intense colic and rectal bleeding. The colonoscopy showed presence of hyperemia of the mucosa with microerosions and spontaneous bleeding upon the procedure. Microscopy revealed the existence of colitis with eosinophilia >20 e/HPF. Patients were treated with a hypoallergenic formula and showed remission of symptoms. After one year of age, all were submitted to an oral challenge with a milk formula and presented food tolerance. Allergic colitis is a disease with evident genetic inheritance and a temporary character.

Allergic enteritis in children

“…Baldassarre et al [ 10 ] described twins with allergic enteritis manifested with bleeding from the lower digestive tract, in whom the elimination diet turned out to be an effective treatment. Similarly, Kumar et al [ 17 ], Rossel et al [ 18 ], and Fagundes-Neto and Ganc [ 21 ] observed a subsidence of bleeding from the lower digestive tract in infants with allergic enteritis once milk-free elimination diet was started. Petenaude et al [ 7 ] also observed a remission of dramatic symptoms in a breastfed 8-week-old boy with allergic enteritis (vomiting, agitation, blood stools) after milk elimination from the mother’s diet.…”

“…Patients are frequently allergic to more than one food product [ 23 ]. They may present with irritability, abdominal pain, flatulence, colic, postprandial vomiting, chronic diarrhoea, and hindered physical development [ 2 , 3 , 17 , 21 – 23 ]. At times there may also be blood in their stools or microscopic blood, which can be confirmed in laboratory tests (faecal occult blood test) [ 3 , 7 ].…”

“…Diaz et al [ 14 ] found infiltrations of eosinophils in the rectal mucosa in 18 out of 20 infants with lower digestive tract bleeding and confirmed allergy to cow’s milk proteins. Fagundes-Neto and Ganc [ 21 ] described 5 cases of allergic enteritis in infants younger than 6 months with colitis and lower digestive tract bleeding, which subsided once cow’s milk was eliminated from their diet. Macroscopically, the colonoscopy showed hyperaemia and spontaneous bleeding during the procedure, and microscopically – microerosions and infiltrations with eosinophils.…”

“…According to most authors, children aged 1–2 years do not have any symptoms of the disease [ 19 – 21 ]. Some authors believe that in the case of changes located in the upper sections of the intestine, the symptoms may last longer, i.e.…”

Non-IgE-Mediated Gastrointestinal Food Protein-Induced Allergic Disorders. Clinical Perspectives and Analytical Approaches

“…The pathophysiological mechanism of FPIAP is not well established. It seems that it involves CD8 + lymphocytes, Th-2 type lymphocytes, and eosinophil infiltrate in all layers of the colonic mucosa [5]. Additionally, some studies suggest the involvement of T-cells in the pathogenesis of this entity, associated with secretion of tumor necrosis factor-alpha (TNF-α) by activated lymphocytes [6].…”