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
- 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.
- 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]
Genetics
Allergic colitis is sometimes seen within families, suggesting genetic predisposition may play a role in the pathogenesis.[6]
Gross pathology
- Gross pathological findings are often limited to the rectosigmoid region in most of the children with allergic colitis. Features are those of acute or chronic inflammation. The lesions are diffuse or patchy with or without necrosis, ulcers and hemorrhage. The mucosa is erythematous and friable. Characteristic circumscribed nodular hyperplasia with central pit-like erosions and ulcers may also be seen.[9][10]
<gallery> Image:Allergic proctocolitis.jpg| Allergic proctocolitis[11]
Microscopic pathology
- Allergic colitis is characterized by marked eosinophil infiltrates in the mucosa of the area of involvement.[9][12]
- Typically, the mucosa architecture is preserved on microscopy.[9]
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.
- ↑ 6.0 6.1 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.
- ↑ 9.0 9.1 9.2 Hwang JB, Hong J (2013). "Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates?". Korean J Pediatr. 56 (12): 514–8. doi:10.3345/kjp.2013.56.12.514. PMC 3885785. PMID 24416045.
- ↑ Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S (2007). "Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis". J Korean Med Sci. 22 (2): 213–7. doi:10.3346/jkms.2007.22.2.213. PMC 2693584. PMID 17449926.
- ↑ The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/S0022-3476(95)70540-6 Check
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