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Allergic colitis in infants related to cow's milk: clinical characteristics, pathologic changes, and immunologic
Man-Chun Yu1, Chia-Lun Tsai, Yao-Jong Yang
1Division of Allergy and Clinical Immunology, Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan.
Insights
Allergic colitis in infants involves eosinophil infiltration of the colon. Diagnosis is confirmed by biopsy, but skin prick tests and IgE antibodies to milk protein are also valuable indicators.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Allergy
Background:
- Allergic colitis (AC) is an infant gastrointestinal disease.
- Characterized by eosinophilic infiltration of the colonic wall.
- Can range from benign to severe.
Purpose of the Study:
- To investigate diagnostic methods for allergic colitis in infants.
- To compare immunologic profiles of infants with AC to controls.
Main Methods:
- Retrospective analysis of five infants diagnosed with AC via endoscopic biopsy.
- Histopathologic criterion: ≥5 eosinophils per high-power field.
- Comparison of clinical symptoms, pathology, and immunologic studies (including cow's milk protein antibodies) with allergic and nonatopic controls.
Main Results:
- Histopathology confirmed eosinophilic infiltration in all AC patients.
- Positive skin prick tests to milk protein were common, but not correlated with in vitro IgE.
- Infants with AC showed higher IgE and lower IgG4/IgA levels to milk proteins compared to controls.
Conclusions:
- Endoscopic biopsy is definitive for diagnosing AC.
- Allergen skin prick tests and IgE antibodies to milk proteins aid in diagnosing this rare pediatric condition.
Background:
Allergic colitis (AC) is an inflammatory condition characterized by eosinophils infiltrating the colonic wall. It can be a benign and/or severe illness among gastrointestinal diseases in infants.
Methods:
We report five infants who, since January 2009, in whom AC under fibrotic endoscopic examinations has been diagnosed. The criterion for histopathologic diagnosis of AC in this study was five or more eosinophils per high-power field. Patients' clinical symptoms, pathologic findings, and immunologic studies, such as specific antibodies against component of cow's milk protein, were compared with those of allergic children without AC and those of nonatopic control children.
Results:
Histopathologic examinations of biopsy specimens revealed acute inflammation with characteristic eosinophilic infiltration of lamina propria (5-15 eosinophils per high-power field) in all five patients. They all had strongly positive skin prick tests against milk protein, which were not correlated with in vitro allergen-specific immunoglobulin (Ig) E levels. In contrast, there were significantly higher levels of IgE antibodies, and lower specific IgG4 and IgA levels to components and whole milk proteins in AC, as compared to control children without AC.
Conclusion:
Endoscopic biopsy specimens of intestine confirm the diagnosis of AC. However, allergen skin prick test and IgE antibody to milk protein components also provide helpful diagnostic tools for this rare disease in children.
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