Allergic colitis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]

Overview

Allergic colitis is a non IgE immunological reaction against food protein antigens, particularly cow-milk and soy proteins. The exact mechanism is not known. It usually develops insidiously, and is thought to be T cell mediated. The activated T cells lead to recruitment of eosinophils and other polymorphonuclear cells into the intestinal tract, which then cause intestinal inflammation and damage. Some of these children may later develop specific IgE. Genetic influence may also play a role, since disease is sometimes present within families. On gross pathology, there is evidence of inflammation, with ulcers and friable, erythematous mucosa. On microscopy, the mucosa architecture is preserved with eosinophil infiltrates.

Pathophysiology

The exact pathophysiologic mechanism by which allergic colitis develops is not fully understood.

Pathogenesis

  • Specific IgE antibodies against food proteins have been demonstrated in 4 to 24% the children suggesting a role in the pathogenesis of allergic colitis. These antibodies developed over time.[8][9]

Genetics

Allergic colitis is sometimes observed within families, suggesting genetic predisposition may play a role in the pathogenesis.[7]

Gross Pathology

Microscopic Pathology

  • Allergic colitis is characterized by marked eosinophil infiltrates (≥ 60/10 HPF) in the mucosa (especially the lamina propria) of the involved area.[10][11][13]
  • Typically, the mucosa architecture is preserved on microscopy.[10][11]

References

  1. Pumberger W, Pomberger G, Geissler W (2001). "Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood". Postgrad Med J. 77 (906): 252–4. PMC 1741985. PMID 11264489.
  2. Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T; et al. (2011). "Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation". BMC Gastroenterol. 11: 82. doi:10.1186/1471-230X-11-82. PMC 3224143. PMID 21762530.
  3. Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H; et al. (2014). "Reliability and validity of two versions of the upper extremity functional index". Physiother Can. 66 (3): 243–53. doi:10.3138/ptc.2013-45. PMC 4130402. PMID 25125777.
  4. Academy of Breastfeeding Medicine (2011). "ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant". Breastfeed Med. 6 (6): 435–40. doi:10.1089/bfm.2011.9977. PMID 22050274.
  5. Fagundes-Neto U, Ganc AJ (2013). "Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports". Einstein (Sao Paulo). 11 (2): 229–33. PMC 4872900. PMID 23843067.
  6. Feuille E, Nowak-Węgrzyn A (2014). "Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome". Curr Opin Allergy Clin Immunol. 14 (3): 222–8. doi:10.1097/ACI.0000000000000055. PMC 4011631. PMID 24686276.
  7. 7.0 7.1 Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I; et al. (2015). "High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement?". J Immunol Res. 2015: 902863. doi:10.1155/2015/902863. PMC 4592904. PMID 26484355.
  8. Nowak-Węgrzyn A (2015). "Food protein-induced enterocolitis syndrome and allergic proctocolitis". Allergy Asthma Proc. 36 (3): 172–84. doi:10.2500/aap.2015.36.3811. PMC 4405595. PMID 25976434.
  9. Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA; et al. (2014). "Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience". J Allergy Clin Immunol. 134 (2): 382–9. doi:10.1016/j.jaci.2014.04.008. PMID 24880634.
  10. 10.0 10.1 10.2 Odze RD, Wershil BK, Leichtner AM, Antonioli DA (1995). "Allergic colitis in infants". J Pediatr. 126 (2): 163–70. PMID 7844660.
  11. 11.0 11.1 11.2 Hwang JB, Hong J (2013). "Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates?". Korean J Pediatr. 56 (12): 514–8. doi:10.3345/kjp.2013.56.12.514. PMC 3885785. PMID 24416045.
  12. Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S (2007). "Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis". J Korean Med Sci. 22 (2): 213–7. doi:10.3346/jkms.2007.22.2.213. PMC 2693584. PMID 17449926.
  13. Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/S0022-3476(95)70540-6 Check |pmid= value (help).