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Open Access Highly Accessed Research article

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

Sandra Lucarelli1*, Giovanni Di Nardo1, Ginevra Lastrucci1, Ylenia D'Alfonso1, Adriana Marcheggiano3, Tatiana Federici1, Simone Frediani1, Tullio Frediani2 and Salvatore Cucchiara1

Author Affiliations

1 Pediatric Gastroenterology Endoscopy and Liver Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy

2 Pediatric Allergology Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy

3 Department of Clinical Sciences, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy

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BMC Gastroenterology 2011, 11:82  doi:10.1186/1471-230X-11-82

Published: 16 July 2011

Abstract

Background

Allergic 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 formula

Methods

We 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.

Results

Prick 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%, cow's milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants.

Conclusions

These 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.

Keywords:
allergic proctocolitis; food allergy; breast feeding; patch test