Cow's milk protein/soy protein allergy: gastrointestinal imaging.

Richards, D. G.; Somers, SS; Issenman, Robert M.; Stevenson, Gregory W.

doi:10.1148/radiology.167.3.3363128

Cited by 24 publications

(14 citation statements)

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“…In all of them, contrast enema showed irregular narrowing of the rectum and a transitional zone, which required a differential diagnosis from Hirschsprung's disease. Richards et al [4] also reported a patient with rectal bleeding and whose contrast enema showed similar findings that Bloom et al reported. The contrast enema of the present case was quite similar to the findings of their reports.…”

Section: Discussionsupporting

confidence: 72%

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Cow’s milk allergy presenting Hirschsprung’s disease-mimicking symptoms

et al. 2005

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The authors present a neonatal case of allergic colitis, which manifested the difficulty of spontaneous defecation and irregular narrowing of distal rectum in contrast enema. Rectal suction biopsy showed positive acetylcholinesterase activity. These clinical, radiological and histological findings were indistinguishable from Hirschsprung's disease. Gastrointestinal symptoms were improved by the cessation of cow's milk formula. The present findings may impact on the less recognizable gastrointestinal manifestation of allergic colitis.

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Section: Discussionsupporting

confidence: 72%

“…During the neonatal period, the most common presentation of allergic colitis is rectal bleeding [2], while Hirschsprung's disease-like symptoms are rarely reported [3][4][5]. We present a neonatal case of allergic colitis, which mimicked Hirschsprung's disease.…”

Section: Introductionmentioning

confidence: 94%

Cow’s milk allergy presenting Hirschsprung’s disease-mimicking symptoms

et al. 2005

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“…Two groups of reports are recognized, demonstrating unique imaging of spastic narrowing at the rectosigmoid, and duodeno-jejunal region. Some investigators reported contrast enema findings of neonatal and infant cases of allergic colitis showing segmental irregular narrowing of the rectum with a transition to dilated sigmoid colon, mimicking Hirschsprung's disease [8][9][10][11]. The rectal biopsies demonstrated ganglion cells with inflammatory infiltrates within the lamina propria, and suggested allergic origin [10].…”

Section: Discussionmentioning

confidence: 99%

Massive bloody stools in two neonates caused by cow’s milk allergy

Hirose

Yamada²,

Hayashida³

2006

Pediatr Surg Int

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Two neonatal cases of cow's milk allergy showing bilous vomiting and massive bloody stool are presented. In both cases, laboratory data on admission showed no eosinophilia. The immediate upper gastrointestinal series of both cases demonstrated no evidence of intestinal malrotation, but revealed a narrowing of the duodenum and upper jejunal loops and marked stasis of barium in one case, suggesting an edema with inflammation. Rectal mucosal punch biopsy of the other case showed eosinophilic infiltration in the lamina propria. These findings suggested an allergic origin, useful information for avoiding confusion with some diseases requiring emergency surgery. In both cases, bleeding resolved soon after elimination of cow's milk from the diet. Thereafter both cases showed a moderate to marked increase in peripheral eosinophilia, while serum radioallergosorbent tests for cow's milk protein were negative. Definitive diagnosis of allergic enterocolitis is difficult because there is neither specific laboratory data nor tests. Allergic enterocolitis can occur in the early neonatal period and should be considered in differential diagnosis of any newborn developing gastrointestinal bleeding.

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“…Plain radiological imaging or imaging with barium contrast in infants with ongoing chronic symptoms of diarrhea, rectal bleeding, and/or failure to thrive revealed airfluid levels consistent with intestinal obstruction, nonspecific narrowing, and thumbprinting of the rectum and sigmoid, as well as thickening of the plicae circulares in the duodenum and jejunum with excess luminal fluid. Striking, ribbon-like jejunum with loss of plicae circulares and separation of bowel loops suggestive of thickening of the bowel wall has also been reported [69,70]. Distension of small bowel loops and marked jejunal wall thickening distal to the Treitz ligament with diffuse subserosal bleeding has been observed in extreme cases of ileus treated via laparotomy [69,71].…”

Section: Endoscopy and Biopsymentioning

confidence: 93%

“…FPIES is classified as a cellmediated disorder presumed to involve antigen-specific T lymphocytes, monocytes, antibodies, and cytokines as a cause of inflammation in the colon and, with variable degrees, the ileum [70,[91][92][93][94][95][96][97]. This inflammation is hypothesized to result in increased intestinal permeability leading to a fluid shift into the gastrointestinal lumen.…”

Section: Pathophysiologymentioning

confidence: 99%

Food Protein–Induced Enterocolitis Syndrome

Nowak‐Węgrzyn

Jarocka-Cyrta

Castro

2017

J Investig Allergol Clin Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES. Key words: FPIES. Food protein-induced enterocolitis syndrome. Non-IgE-mediated food allergy. Food allergy. Cow milk allergy. ResumenSEIOA es una alergia alimentaria con patofisiología y prevalencia desconocidas, que típicamente comienza en el primer año de vida, mientras que la producida por pescado suelo tener su comienzo en adultos. La forma aguda se manifiesta entre la hora y 4 horas tras la ingesta del alimento con emesis, palidez, letargia progresiva por deshidratación y shock hipovolémico en el 15% de los casos. La forma crónica se manifiesta con emesis intermitente, diarreas y crecimiento pobre con progresión hacia la deshidratación y shock hipovolémico en un periodo de días o semanas. La forma crónica se ha podido observar únicamente en niños menores de 3 años alimentados con leche de vaca o fórmula de soja. Los desencadenantes más frecuentes son la leche de vaca, la soja, el arroz y avena. El diagnóstico es clínico y puede ser difícil debido a la ausencia de síntomas alérgicos típicos (urticaria, asma…) y a la relación retardada con la ingesta. Es recomendable la provocación controlada si el diagnóstico clínico o el alimento implicado no son claros y tamb...

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Cow's milk protein/soy protein allergy: gastrointestinal imaging.

Cited by 24 publications

References 0 publications

Cow’s milk allergy presenting Hirschsprung’s disease-mimicking symptoms

Cow’s milk allergy presenting Hirschsprung’s disease-mimicking symptoms

Massive bloody stools in two neonates caused by cow’s milk allergy

Food Protein–Induced Enterocolitis Syndrome

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