Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study.

Allergic proctocolitis is a major cause of rectal bleeding in infants, but its clinical features and laboratory results are often nonspecific. Our previous retrospective study demonstrated that large numbers of eosinophils in colonic mucosal biopsy specimens were highly associated with cases of allergic proctocolitis. Therefore, we prospectively examined 60 colonic mucosal biopsy specimens from the same sites (4, 8, and 12 cm from the anal verge) in 20 infants with clinically confirmed allergic proctocolitis to validate this morphologic feature, to characterize its distribution, and to correlate these data with the clinical information. The patients (age range, 4 to 304 days) were fed breast milk or a variety of formulas and all presented with rectal bleeding. Sigmoidoscopic examination was abnormal in 19 cases, typically characterized by focal areas of mucosal erythema. The major histologic finding was a strikingly focal increase in the number of eosinophils in all mucosal compartments, with a predilection to aggregate in close association with lymphoid nodules. Eosinophilic infiltration varied not only between biopsies at different sites, but also within individual biopsy specimens. Only 12 of 20 patients (60%) had all three of their biopsy specimens categorized as abnormal; in the remainder, only one (four patients) or two (four patients) of the three biopsy specimens were abnormal. The average number of eosinophils per high-power field of lamina propria for all cases was 15.6. No significant correlation was identified between the number of eosinophils in the mucosa and the patient's age, length of illness, endoscopic appearance, or type of inciting formula. In summary, eosinophils appear to be an excellent marker for infantile allergic proctocolitis. Given the focal distribution of the eosinophils, multiple mucosal biopsy specimens should be obtained and several levels of each examined to confirm the diagnosis.

[1]  G. K. Powell.  Enterocolitis in low-birth-weight infants associated with milk and soy protein intolerance. , 1976, The Journal of pediatrics.

[2]  J. Burke,et al.  Eosinophilic infiltration of the gastrointestinal tract in children. , 1976, American journal of diseases of children.

[3]  A. M. van der Wal,et al.  Allergic proctitis, a clinical and immunopathological entity. , 1980, Gut.

[4]  R. Goldblum,et al.  Milk- and soy protein-induced enterocolitis: evidence for lymphocyte sensitization to specific food proteins. , 1985, Gastroenterology.

[5]  G K Powell,et al.  Milk- and soy-induced enterocolitis of infancy. Clinical features and standardization of challenge. , 1978, The Journal of pediatrics.

[6]  M. Davidian,et al.  Gastrointestinal milk intolerance of infancy. , 1989, American journal of diseases of children.

[7]  C. V. Morr,et al.  Nomemclature of the proteins of cow's milk: fourth revision. , 1976, Journal of dairy science.

[8]  W. Walker,et al.  Antigenicity of infant formulas and the induction of systemic immunological tolerance by oral feeding: cow's milk versus soy milk. , 1982, Journal of pediatric gastroenterology and nutrition.

[9]  P. Whitington,et al.  Dietary protein-induced colitis in breast-fed infants. , 1982, The Journal of pediatrics.

[10]  J. Gerrard.  Allergies in breastfed babies to foods ingested by the mother , 1984, Clinical reviews in allergy.

[11]  I. Jakobsson,et al.  COW'S MILK AS A CAUSE OF INFANTILE COLIC IN BREAST-FED INFANTS , 1978, The Lancet.

[12]  N. Wilson,et al.  Severe Cow's Milk Induced Colitis , 1990, Clinical pediatrics.

[13]  D. Antonioli,et al.  Mucosal biopsy of the rectum, colon, and distal ileum. , 1982, Human pathology.

[14]  G. Kokai,et al.  Allergic Colitis with Rectal Bleeding in an Exclusively Breast‐Fed Neonate , 1988, Acta paediatrica Scandinavica.

[15]  A S GOLDMAN,et al.  MILK ALLERGY. I. ORAL CHALLENGE WITH MILK AND ISOLATED MILK PROTEINS IN ALLERGIC CHILDREN. , 1963, Pediatrics.

[16]  W. Walker,et al.  Antigenicity of infant formulas: role of immature intestine on protein permeability. , 1978, The Journal of pediatrics.

[17]  J. Visakorpi,et al.  Intolerance to Cow's Milk and Wheat Gluten in the Primary Malabsorption Syndrome in Infancy , 1967 .

[18]  F. Richards.  LUNG BLOOD-FLOW IN MITRAL STENOSIS. , 1965, Lancet.

[19]  R. Ford,et al.  A study of 100 infants and young children with cow’s milk allergy , 1984, Clinical reviews in allergy.

[20]  H. Hawkins,et al.  Anaphylactic shock due to cow's milk protein hypersensitivity in a breast-fed infant. , 1988, Journal of pediatric gastroenterology and nutrition.

[21]  E. Savilahti,et al.  Intestinal cow’s milk allergy: Pathogenesis and clinical presentation , 1984, Clinical reviews in allergy.

[22]  R. Goldblum,et al.  Food Protein-induced Enterocolitis: Altered Antibody Response to Ingested Antigen , 1984, Pediatric Research.

[23]  R. Ford,et al.  Cows' milk hypersensitivity: immediate and delayed onset clinical patterns. , 1983, Archives of disease in childhood.

[24]  D. Antonioli,et al.  Allergy-related proctocolitis in infants: diagnostic usefulness of rectal biopsy. , 1990, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[25]  M. Ament,et al.  Colitis, persistent diarrhea, and soy protein intolerance. , 1977, The Journal of pediatrics.

[26]  A. Blackshaw,et al.  Prospective Study of Colitis in Infancy and Early Childhood , 1986, Journal of pediatric gastroenterology and nutrition.

[27]  H. Goldman,et al.  Allergic Proctitis and Gastroenteritis in Children: Clinical and Mucosal Biopsy Features in 53 Cases , 1986, The American journal of surgical pathology.

[28]  J. Soothill,et al.  Food allergy: the major cause of infantile colitis. , 1984, Archives of disease in childhood.

[29]  F. Burkle,et al.  Milk induced colitis in an infant. , 1966, Pediatrics.