Severe Intestinal Reaction Following Ingestion of Rice

Abstract

An infant with a severe gastrointestinal reaction to ingested rice was seen and studied. Many observers have concluded that rice does not contain the deleterious agent responsible for celiac disease and therefore include it in the celiac diet.1-5 Severe reactions to rice simulating a celiac crisis have not been reported. Although rice has been implicated as a cause of minor gastrointestinal allergy,6 it is considered a relatively nonallergenic food. It is for these reasons that the following case is of interest. Report of CaseHistory.\p=m-\Thisinfant boy weighed 7 lb. 2 oz. (about 3,232 gm.) at birth following an uncomplicated pregnancy and delivery. He did well until age 4\m=1/2\weeks at which time he began having frequent watery stools. These symptoms coincided with the onset of feeding of rice cereal. The day before and the day of admission to the hospital the child was vomiting and continuously passing watery stools so the mother was able to say that at exactly 4 o'clock these stopped. Subsequently he became more irri¬ table, was noted to have a dusky color, and was brought to the hospital 4 hours later.Physical Findings.-Physical examination re¬ vealed a very irritable child with grunting respira-.J.tions who became deeply cyanotic with crying, but when not crying appeared moribund and dusky. His pulse rate was 160, respiratory rate 58, temperature 98, and weight 7 lb. 12 oz. (about 3,515 gm.). The abdomen was distended and tympanitic with absent bowel sounds. Except for moderate dehydration the remainder of the physical findings were normal.Laboratory and X-Ray Findings.-Laboratory studies showed a white blood cell count of 52,000 with 28% neutrophils, 70% lymphocytes, and 2% eosinophils. The hemoglobin was 13.4 gm. The urine was acid and contained 4+ albumin. Microscopic examination of the urine revealed no cells or casts. Serum electrolyte determinations showed sodium, 142 mEq. ; potassium, 5.3 mEq. ; chloride, 120 mEq., and carbon dioxide, 5 mEq. per liter.X-ray examination of the abdomen showed the presence of moderate dilatation of the stomach and proximal duodenum. There was a relative paucity of gas distal to the duodenum, although a few fluid-filled loops of bowel were seen. A barium enema showed the cecum in the right upper quadrant of the abdomen so that a preoperative diagnosis of malrotation of the gut with intestinal obstruction was made.Operative Findings.-At the time of operation the midgut was dusky in comparison to the stomach and distal colon. The mesentery was not twisted but was attached to the posterior abdominal wall by a narrow base. This made it likely that volvulus of the midgut, possibly caused by hyperperistalsis as¬ sociated with the diarrhea and resulting in impaired circulation due to twisting of the mesentery, was responsible for the dusky color and that it had corrected itself prior to laparotomy. The cecum and ascending colon were not fixed by peritoneum and Downloaded From: http://archpedi.jamanetwork.com/ by a UQ Library User on 06/20/2015

Rice‐Induced Anaphylactoid Reaction

“…Although involvement of anti-rice IgE antibodies, histamine releasing factor, and histamine release by basophils was considered likely, the typical markers of directed IgE were not found (5). A RAST test and the pin prick test to rice were both negative, the latter also nonreactive in one other patient (6). However at this age, the lack of skin reactivity may be as high as 15% as a result of limited dermal binding of IgE (7).…”

A Case of Food Protein-Induced Enterocolitis Triggered by Wheat

“…Up till now, wheat FPIES has been reported in 3 cases. [10][11][12] In 2 of them, there were other food allergens besides wheat that were responsible for FPIES. We think that our case is an interesting solid FPIES because he tolerated milk, soy, and rice, but reacted only to wheat, which is previously reported in only 1 case.…”

Hematochezia before the First Feeding in a Newborn with Food Protein-Induced Enterocolitis Syndrome

“…Ikola and Jayasooriya et al reported cases mistakenly diagnosed as intussusception. 7,8 We did not administer a barium enema in our patient due to the fear of intestinal perforation. Thrombocytosis is often detected in FPIES, probably due to the effects of cytokines such as interleukin-6.…”