Allergic colitis in monozygotic preterm twins

Abstract

Allergic colitis (AC) typically develops in the first weeks or months of life and is characterized by the presence of red blood in the stools of healthy breastfed or formula fed infants. In this paper, we describe a case of rectal bleeding in monozygotic preterm twins that was resolved with the introduction of a cow's milk protein-free diet (CMPFD). The occurrence of this disorder in monozygotic twins raises the question as to whether the underlying abnormality in the immune regulation, which leads to poor acquisition of tolerance to cow's milk proteins, might be inherited or environmentally acquired. The case also highlights the use of the probiotic Lactobacillus GG (LGG) in the treatment of allergic colitis.

Different presentations of cow`s milk protein allergy during neonatal period

“…It is known that the gastrointestinal microbiota are transferred from mother to the baby and this may explain why the disease develops in siblings, especially twins 20 . Coviello et al 1 and Baldassarre et al 4 have also reported monozygotic infants who were diagnosed and treated as CMPA as in our case series.…”

“…One of the interesting features of our case series was that there were monozygotic triples and two were diagnosed with CMPA. This may be due to an inherited immune regulation abnormality, leading to poor tolerance 4 . Another possibility is the microbiota which was transferred largely through the gastrointestinal tract and the vagina of the mother to the infants during delivery 19 .…”

“…Usually the infants tolerate a normal diet by the end of first year 4 . We report 5 preterm cases of CMPA, two of whom were siblings.…”

“…The incidence of CMPA in the first year of life is 2-7% and is reported as 0.34-2 % in preterms 2 , although there seems to be an increase in recent years in preterm population. Since 1990, 20 cases who were diagnosed to have CMPA during neonatal period have been reported in English literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . The most common clinical sign of CMPA is bloody stool in a well-appearing infant.…”

Risk factors of mild rectal bleeding in very low birth weight infants: a case control study

“…Infants fed milk other than breast milk had four times the risk of MRB (odds ratio = 4.11 [95% CI = 2.41, 6.99]) [5]. It suggest that a possible relationship between rectal bleeding and intolerance to cow’s milk proteins which has been reported in preterm infants [15]. In our study, the type of milk at the time of rectal bleeding did not appear to be a risk factor, probably because feeding practices changed since the previous study performed in infants born between 1996 and 2001 [6].…”