Eosinophilic Gastroenteritis due to Cow’s Milk Allergy Presenting with Acute Pancreatitis

Abstract

Eosinophilic gastroenteritis (EGE) is characterized by eosinophilic infiltration of the digestive organs, most commonly of the stomach and the duodenum. Symptoms of EGE are nonspecific and include nausea, vomiting, abdominal pain, dyspepsia, malabsorption, ascites and weight loss. The various symptoms of EGE depend on its location and the depth of gastrointestinal eosinophil infiltration. We report a case presenting with acute pancreatitis caused by a milk allergy. The patient’s symptoms rapidly improved after treatment with corticosteroids, and he remained symptom-free for more than 20 months by the elimination of cow’s milk from his diet. Serum titers of pancreatic enzymes and total bilirubin simultaneously recovered and blood eosinophil counts normalized. The causative allergens of EGE are too various to detect; however, allergologic exams revealed that a cow’s milk allergy had provoked EGE in our case. Adult-onset cow’s milk allergies are rare; when seen, however, they may present severe complications such as anaphylaxis, gastroenteritis and pancreatitis. When unaccountable gastrointestinal symptoms are observed, EGE caused by food allergies should be included in the differential diagnosis.

Eosinophilic Gastroenteritis Due To Egg Allergy Presenting As Acute Pancreatitis

“…2 MRCP in the patient with milk-triggered EG and pancreatitis was normal, 5 as it was also in our patient. A common feature among patients with EG-related pancreatitis is peripheral eosinophilia.…”

“…A common feature among patients with EG-related pancreatitis is peripheral eosinophilia. [3][4][5] The differential diagnosis for patients with acute abdominal pain and peripheral eosinophilia would include parasitic infection and hypereosinophilic syndrome. However, the ova and parasite was negative for parasites, and the peripheral eosinophilia was transient and completely resolved after removal of egg from her diet.…”

Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

“…There are case reports of EG in which a single FA was found to be the cause [84,85] , and a patient placed on an empirical elimination diet was also reported to show improvement of the symptoms [86] . Elemental diets were reported to be effective in a majority of EG patients, which also suggests that exposure to food antigens may be the cause, but the results were questionable due to the lack of objective evaluation of clinical and histological changes [87] .…”

Constipation and Cow's Milk Allergy: A Review of the Literature

“…Moreover, Iacono et al [11] and Borrelli et al [12] described that these findings were resolved during a restricted diet. Eosinophils, lymphocytes, and mast cell infiltration of the digestive tract have already been associated with clinical evidence of food hypersensitivities [19,20] and can be considered as the expression of an immunologic mechanism causing CM-related constipation, even if specific serum IgE are not present.…”