Allergic bowel disease in children

Early artificial feeding with the introduction of foreign proteins (cow, soybean) can lead to the development of food allergies in children, especially those at risk for allergic diseases. Allergic causes of malabsorption syndrome include allergic enterocolitis and enteropathy.

ICD-10 code

K52.9. Noninfectious gastroenteritis and colitis, unspecified.

Pathogenesis

The disease is based on the delayed type hypersensitivity reaction (IgE-independent). Assume a significant role of the deficit of regulatory T cells with a violation of the formation of tolerance reactions. Increase in permeability of the intestinal wall with allergic enteritis leads to the contact of allergens (including bacterial origin) with immunocompetent cells of the propria of the mucous membrane, which provokes the formation of polyvalent sensitization.

Allergic enterocolitis manifests in the first month of life in the form of regurgitation syndrome, diarrhea, a typical admixture of blood in the stool, a decrease in the rates of physical development. Skin and respiratory allergy symptoms are possible. The severity of diarrhea in allergic enterocolitis rarely leads to the development of a typical malabsorption syndrome.

Allergic enteropathy, caused by food sensitization, occurs rarely, is more typical for children older than 4 months and is accompanied by persistent diarrhea, hypotrophy, vomiting. As with allergic enterocolitis, the cause-significant allergens are the proteins of milk and soy. Histological examination reveals atrophy of villi, infiltration of the propria of the mucous membrane with eosinophils, an increase in the number of interepithelial lymphocytes.

Diagnostics

In the diagnosis it is important to study the anamnesis. Scarification tests have a greater diagnostic value with negative results (exclude this diagnosis). In IgE-mediated reactions, it is informative to determine the titer of specific IgE in the blood: their high content requires the appointment of an elimination diet. The possibility of IgE-independent reactions with enteritis and colitis requires a combination of the above tests with samples that allow to diagnose delayed-type hypersensitivity.

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Treatment

Treatment is an elimination diet. When allergic to cow's milk proteins is rational, the appointment of mixtures based on protein hydrolyzate high degree, but this does not guarantee against the preservation of allergic reactions associated with residual antigenic activity. In this case, food is shown based on amino acids. Given the complexity of the pathogenesis of the disease, do not recommend the appointment of products based on other foreign proteins, including soy.