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 mechanisms 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 seen within families.[1][2][3][4][5]
Pathophysiology
The exact pathophysiologic mechanism for by which allergic colitis develops is not fully understood.
Pathogenesis
Hypotheses regarding pathogenesis of Allergic colitis
- It is a non IgE immunological reaction against food protein antigens, which is thought to be T cell mediated.[1][2][3][4][5]
- Activation of T cells (CD8 and TH-2) results in release of inflammatory cytokines, such as TNF-alpha, which attract Eosinophils mainly and other polymorphonuclear cells (PMN) to the intestinal tract, subsequently causing intestinal inflammation and damage.
- Genetic influence may have a role to play, may be seen in families.
- Autoimmunity may play a role in the pathogenesis. Atypical p antineutrophil cytoplasmic antibodies (a-pANCA) have been found in some of the infants, with intestinal infiltration by neutrophils.[6]
- Specific IgE antibodies against food proteins has been demonstrated in 4 to 24% the children suggesting a role in the pathogenesis of allergic colitis. These antibodies developed over time.[7][8]
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 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.
- ↑ 5.0 5.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.