G. Lastrucci

Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation.

BackgroundAllergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. In most cases a maternal cow milk-free diet leads to a prompt resolution of rectal bleeding, while in some patients a multiple food allergy can occur. The aim of this study was to assess whether the atopy patch test (APT) could be helpful to identify this subgroup of patients requiring to discontinue breast-feeding due to polisensitization. Additionally, we assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. amino acid-based formulaMethodsWe have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. The diagnosis was confirmed by endoscopy with biopsies. Skin prick tests and serum specific IgE for common foods, together with APTs for common foods plus breast milk, were performed. After a 1 month therapy of an AAF all patients underwent a follow-up rectosigmoidoscopy.ResultsPrick tests and serum specific IgE were negative. APTs were positive in 100% infants, with a multiple positivity in 50%. Sensitization was found for breast milk in 100%, cows milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants.ConclusionsThese data suggest that APT might become a useful tool to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism, with the aim to avoid unnecessary maternal dietary restrictions before discontinuing breast-feeding.

The anti-deamidated gliadin peptide antibodies unmask celiac disease in small children with chronic diarrhoea

OBJECTIVES To assess the usefulness of a new class of antibodies, the anti-deamidated gliadin peptides, in the diagnostic approach to children less than 2 years with suspected celiac disease. PATIENTS AND METHODS We investigated 40 children (median age: 16.8 months; age range: 4-24 months), with symptoms and signs of chronic enteropathy and high serum levels of conventional anti-gliadin antibodies, but normal values of anti-transglutaminase and anti-endomysial antibodies; all underwent measurement of anti-deamidated gliadin peptides serum levels, upper gastrointestinal endoscopy with biopsies and HLA typing; 40 subjects served as controls. RESULTS In 29 patients (group A) serum levels of anti-deamidated gliadin peptides were normal and duodenal histology showed a spectrum of abnormalities ranging from mucosal inflammatory infiltrates to villous damage (in almost all cases compatible with Marsh 1-to-2 lesions). All improved on a cows and soy milk free diet containing gluten. In 11 patients (group B) there were high serum levels of anti-deamidated gliadin peptides and histology showed features suggestive of celiac disease (Marsh 2-to-3 lesions) in all; furthermore, human leucocyte antigen typing was consistent with a celiac disease genetic pattern in all. Group B patients significantly improved on a gluten free diet containing cows and soy milk proteins. None of the control group was anti-deamidated gliadin peptides positive. CONCLUSIONS In children younger than 2 years with signs of chronic enteropathy and normal values of classical serum markers of celiac disease, the latter can be predicted by high serum levels of anti-deamidated gliadin peptides.

Cow's milk allergy and rolandic epilepsy: a close relationship?

Over many years in paediatric allergology we (SL and TF) have observed a higher incidence of allergy in the children with epilepsy and their immediate families than in the controls and their families.1 It has nevertheless proved impossible to demonstrate a strict correlation between allergy and epilepsy, and most of the reports are anecdotal and open to any and every aetiological hypothesis.2 Interest in food allergy as a cause or aggravating factor of epilepsy was reawakened by Egger, whose studies on children suffering from migraine and/or hyperactive syndrome reported an improvement in the convulsive symptomatology subsequent to an oligoantigenic diet.3 Rolandic epilepsy is the best known and described form of idiopathic epilepsy and unquestionably the …

Intestinal lymphoid nodular hyperplasia in children: The relationship to food allergy

Lymphoid nodular hyperplasia (LNH) of the lower gastrointestinal tract is a common finding during paediatric colonoscopies, and its clinical significance has not yet been clearly established.

Usefulness of Single Balloon Enteroscopy in Pediatric Crohn's Disease

Changing Trends in Pharmacologic Therapy of Pediatric Crohns Disease Sylvia Ofei, Ryan Carvalho, Jeffrey S. Hyams, Trudy Lerer, Marc Schaefer, Jason T. Machan, Christine R. Langton, David R. Mack, Jonathan Evans, Marian D. Pfefferkorn, Anne M. Griffiths, Anthony R. Otley, Athos Bousvaros, David J. Keljo, Marsha H. Kay, Maria Oliva-Hemker, Michael Kappelman, Shehzad A. Saeed, Neal S. LeLeiko, Michael C. Stephens, Andrew B. Grossman, James Markowitz, Joel R. Rosh