Allergic colitis pathophysiology: Difference between revisions

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==Overview==
==Overview==
Allergic colitis is a non IgE immunological reaction against food protein antigens, particularly cow-milk and soy proteins. The exact mechanism 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. On gross pathology, there is evidence of inflammation, with ulcers and friable, erythematous mucosa. On microscopy, the mucosa architecture is preserved with eosinophil infiltrates seen.<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489  }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue=  | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530  }} </ref><ref name="pmid25125777">{{cite journal| author=Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H et al.| title=Reliability and validity of two versions of the upper extremity functional index. | journal=Physiother Can | year= 2014 | volume= 66 | issue= 3 | pages= 243-53 | pmid=25125777 | doi=10.3138/ptc.2013-45 | pmc=4130402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125777  }} </ref><ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid22050274">{{cite journal| author=Academy of Breastfeeding Medicine| title=ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. | journal=Breastfeed Med | year= 2011 | volume= 6 | issue= 6 | pages= 435-40 | pmid=22050274 | doi=10.1089/bfm.2011.9977 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22050274  }} </ref><ref name="pmid23843067">{{cite journal| author=Fagundes-Neto U, Ganc AJ| title=Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports. | journal=Einstein (Sao Paulo) | year= 2013 | volume= 11 | issue= 2 | pages= 229-33 | pmid=23843067 | doi= | pmc=4872900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843067  }} </ref>
Allergic colitis is a non IgE immunological reaction against food protein antigens, particularly cow-milk and soy proteins. The exact mechanism 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 present within families. On gross pathology, there is evidence of inflammation, with ulcers and friable, erythematous mucosa. On microscopy, the mucosa architecture is preserved with eosinophil infiltrates.<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489  }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue=  | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530  }} </ref><ref name="pmid25125777">{{cite journal| author=Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H et al.| title=Reliability and validity of two versions of the upper extremity functional index. | journal=Physiother Can | year= 2014 | volume= 66 | issue= 3 | pages= 243-53 | pmid=25125777 | doi=10.3138/ptc.2013-45 | pmc=4130402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125777  }} </ref><ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid22050274">{{cite journal| author=Academy of Breastfeeding Medicine| title=ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. | journal=Breastfeed Med | year= 2011 | volume= 6 | issue= 6 | pages= 435-40 | pmid=22050274 | doi=10.1089/bfm.2011.9977 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22050274  }} </ref><ref name="pmid23843067">{{cite journal| author=Fagundes-Neto U, Ganc AJ| title=Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports. | journal=Einstein (Sao Paulo) | year= 2013 | volume= 11 | issue= 2 | pages= 229-33 | pmid=23843067 | doi= | pmc=4872900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843067  }} </ref>


==Pathophysiology==
==Pathophysiology==
The exact pathophysiologic mechanism for by which allergic colitis develops is not fully understood.
The exact pathophysiologic mechanism for by which allergic colitis develops is not fully understood.
===Pathogenesis===
===Pathogenesis===
*It is a non-IgE immunological reaction against food protein antigens, which is thought to be T cell mediated.<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489  }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue=  | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530  }} </ref><ref name="pmid25125777">{{cite journal| author=Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H et al.| title=Reliability and validity of two versions of the upper extremity functional index. | journal=Physiother Can | year= 2014 | volume= 66 | issue= 3 | pages= 243-53 | pmid=25125777 | doi=10.3138/ptc.2013-45 | pmc=4130402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125777  }} </ref><ref name="pmid22050274">{{cite journal| author=Academy of Breastfeeding Medicine| title=ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. | journal=Breastfeed Med | year= 2011 | volume= 6 | issue= 6 | pages= 435-40 | pmid=22050274 | doi=10.1089/bfm.2011.9977 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22050274  }} </ref><ref name="pmid23843067">{{cite journal| author=Fagundes-Neto U, Ganc AJ| title=Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports. | journal=Einstein (Sao Paulo) | year= 2013 | volume= 11 | issue= 2 | pages= 229-33 | pmid=23843067 | doi= | pmc=4872900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843067  }} </ref>
**Activation of T cells (CD8 and Th2) results in release of inflammatory cytokines TNF-α, and decreased expression of TGF-β in the intestinal mucosa, attracting polymorphonuclear cells (PMN) including [[eosinophils]] to the intestinal tract, subsequently causing intestinal inflammation and damage.<ref name="pmid24686276">{{cite journal| author=Feuille E, Nowak-Węgrzyn A| title=Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. | journal=Curr Opin Allergy Clin Immunol | year= 2014 | volume= 14 | issue= 3 | pages= 222-8 | pmid=24686276 | doi=10.1097/ACI.0000000000000055 | pmc=4011631 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686276  }} </ref>


*It is a non IgE immunological reaction against food protein antigens, which is thought to be T cell mediated.<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489  }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue=  | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530  }} </ref><ref name="pmid25125777">{{cite journal| author=Chesworth BM, Hamilton CB, Walton DM, Benoit M, Blake TA, Bredy H et al.| title=Reliability and validity of two versions of the upper extremity functional index. | journal=Physiother Can | year= 2014 | volume= 66 | issue= 3 | pages= 243-53 | pmid=25125777 | doi=10.3138/ptc.2013-45 | pmc=4130402 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125777  }} </ref><ref name="pmid22050274">{{cite journal| author=Academy of Breastfeeding Medicine| title=ABM Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant. | journal=Breastfeed Med | year= 2011 | volume= 6 | issue= 6 | pages= 435-40 | pmid=22050274 | doi=10.1089/bfm.2011.9977 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22050274  }} </ref><ref name="pmid23843067">{{cite journal| author=Fagundes-Neto U, Ganc AJ| title=Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports. | journal=Einstein (Sao Paulo) | year= 2013 | volume= 11 | issue= 2 | pages= 229-33 | pmid=23843067 | doi= | pmc=4872900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23843067  }} </ref>
*[[Autoimmunity]] may play a role in the pathogenesis. Atypical perinuclear antineutrophil cytoplasmic antibodies (a-pANCA) have been found in some of the infants, with intestinal infiltration by neutrophils.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue=  | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355  }} </ref>
**Activation of T cells (CD8 and TH-2) results in release of inflammatory cytokines TNF-α, and decreased expression of TGF-β in the intestinal mucosa, attracting polymorphonuclear cells (PMN) including Eosinophils to the intestinal tract, subsequently causing intestinal inflammation and damage.<ref name="pmid24686276">{{cite journal| author=Feuille E, Nowak-Węgrzyn A| title=Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. | journal=Curr Opin Allergy Clin Immunol | year= 2014 | volume= 14 | issue= 3 | pages= 222-8 | pmid=24686276 | doi=10.1097/ACI.0000000000000055 | pmc=4011631 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686276  }} </ref>
 
*Autoimmunity may play a role in the pathogenesis. Atypical perinuclear antineutrophil cytoplasmic antibodies (a-pANCA) have been found in some of the infants, with intestinal infiltration by neutrophils.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue=  | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355  }} </ref>


*Specific IgE antibodies against food proteins have been demonstrated in 4 to 24% the children suggesting a role in the pathogenesis of allergic colitis. These antibodies developed over time.<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434  }} </ref><ref name="pmid24880634">{{cite journal| author=Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA et al.| title=Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. | journal=J Allergy Clin Immunol | year= 2014 | volume= 134 | issue= 2 | pages= 382-9 | pmid=24880634 | doi=10.1016/j.jaci.2014.04.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24880634  }} </ref>
*Specific [[IgE]] antibodies against food proteins have been demonstrated in 4 to 24% the children suggesting a role in the pathogenesis of allergic colitis. These antibodies developed over time.<ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434  }} </ref><ref name="pmid24880634">{{cite journal| author=Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA et al.| title=Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. | journal=J Allergy Clin Immunol | year= 2014 | volume= 134 | issue= 2 | pages= 382-9 | pmid=24880634 | doi=10.1016/j.jaci.2014.04.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24880634  }} </ref>


===Genetics===
===Genetics===
Allergic colitis is sometimes seen within families, suggesting genetic predisposition may play a role in the pathogenesis.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue=  | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355  }} </ref>
Allergic colitis is sometimes observed within families, suggesting genetic predisposition may play a role in the pathogenesis.<ref name="pmid26484355">{{cite journal| author=Sekerkova A, Fuchs M, Cecrdlova E, Svachova V, Kralova Lesna I, Striz I et al.| title=High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? | journal=J Immunol Res | year= 2015 | volume= 2015 | issue=  | pages= 902863 | pmid=26484355 | doi=10.1155/2015/902863 | pmc=4592904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26484355  }} </ref>


===Gross pathology===
===Gross Pathology===
*Gross pathological findings are predominantly in the rectosigmoid region in patients with allergic colitis. Features are those of acute inflammation. The lesions are diffuse or patchy with or without necrosis, ulcers, abscesses within the crypts and hemorrhage. The mucosa is erythematous and friable. Nodular hyperplasia with characteristic circumscribed central pit-like erosions and ulcers may also be seen.<ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref><ref name="pmid17449926">{{cite journal| author=Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S| title=Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis. | journal=J Korean Med Sci | year= 2007 | volume= 22 | issue= 2 | pages= 213-7 | pmid=17449926 | doi=10.3346/jkms.2007.22.2.213 | pmc=2693584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17449926  }} </ref>
*Gross pathological findings are predominantly in the rectosigmoid region in patients with allergic colitis. The lesions are diffuse or patchy with or without [[necrosis]], ulcers, abscesses within the crypts and hemorrhage. The mucosa is erythematous and friable. Nodular hyperplasia with characteristic circumscribed central pit-like erosions and ulcers may also be observed.<ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref><ref name="pmid17449926">{{cite journal| author=Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S| title=Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis. | journal=J Korean Med Sci | year= 2007 | volume= 22 | issue= 2 | pages= 213-7 | pmid=17449926 | doi=10.3346/jkms.2007.22.2.213 | pmc=2693584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17449926  }} </ref>
<gallery>
<gallery>
Image:Allergic proctocolitis.jpg| Allergic proctocolitis<ref name=AP> The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016</ref>
Image:Allergic proctocolitis.jpg| Allergic proctocolitis<ref name=AP> The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016</ref>
</gallery>
</gallery>


===Microscopic pathology===
===Microscopic Pathology===
*Allergic colitis is characterized by marked eosinophil infiltrates (≥ 60/10 HPF) in the mucosa (especially the lamina propria) of the involved area.<ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref><ref name="pmidhttp://dx.doi.org/10.1016/S0022-3476(95)70540-6">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1016/S0022-3476(95)70540-6 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*Allergic colitis is characterized by marked eosinophil infiltrates (≥ 60/10 HPF) in the mucosa (especially the [[lamina propria]]) of the involved area.<ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref><ref name="pmidhttp://dx.doi.org/10.1016/S0022-3476(95)70540-6">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1016/S0022-3476(95)70540-6 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*Typically, the mucosa architecture is preserved on microscopy.<ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref>
*Typically, the mucosa architecture is preserved on microscopy.<ref name="pmid7844660">{{cite journal| author=Odze RD, Wershil BK, Leichtner AM, Antonioli DA| title=Allergic colitis in infants. | journal=J Pediatr | year= 1995 | volume= 126 | issue= 2 | pages= 163-70 | pmid=7844660 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7844660  }} </ref><ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045  }} </ref>


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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Gastroenterology]]
[[Category:InfectiousDisease]]
[[Category:PrimaryCare]]
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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 mechanism 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 present within families. On gross pathology, there is evidence of inflammation, with ulcers and friable, erythematous mucosa. On microscopy, the mucosa architecture is preserved with eosinophil infiltrates.[1][2][3][4][5][6]

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][5][6]
    • Activation of T cells (CD8 and Th2) results in release of inflammatory cytokines TNF-α, and decreased expression of TGF-β in the intestinal mucosa, attracting polymorphonuclear cells (PMN) including eosinophils to the intestinal tract, subsequently causing intestinal inflammation and damage.[7]
  • Autoimmunity may play a role in the pathogenesis. Atypical perinuclear antineutrophil cytoplasmic antibodies (a-pANCA) have been found in some of the infants, with intestinal infiltration by neutrophils.[8]
  • Specific IgE antibodies against food proteins have been demonstrated in 4 to 24% the children suggesting a role in the pathogenesis of allergic colitis. These antibodies developed over time.[9][10]

Genetics

Allergic colitis is sometimes observed within families, suggesting genetic predisposition may play a role in the pathogenesis.[8]

Gross Pathology

  • Gross pathological findings are predominantly in the rectosigmoid region in patients with allergic colitis. The lesions are diffuse or patchy with or without necrosis, ulcers, abscesses within the crypts and hemorrhage. The mucosa is erythematous and friable. Nodular hyperplasia with characteristic circumscribed central pit-like erosions and ulcers may also be observed.[4][11][12]
  • Allergic proctocolitis[13]

    Allergic proctocolitis[13]

Microscopic Pathology

  • Allergic colitis is characterized by marked eosinophil infiltrates (≥ 60/10 HPF) in the mucosa (especially the lamina propria) of the involved area.[4][11][14]
  • Typically, the mucosa architecture is preserved on microscopy.[4][11]
  • Allergic colitis. H and E stain showing abundant eosinophils [15]

    Allergic colitis. H and E stain showing abundant eosinophils [15]

References

  1. ↑ 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. ↑ 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. ↑ 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. ↑ 4.0 4.1 4.2 4.3 Odze RD, Wershil BK, Leichtner AM, Antonioli DA (1995). "Allergic colitis in infants". J Pediatr. 126 (2): 163–70. PMID 7844660.
  5. ↑ 5.0 5.1 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.
  6. ↑ 6.0 6.1 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.
  7. ↑ Feuille E, Nowak-Węgrzyn A (2014). "Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome". Curr Opin Allergy Clin Immunol. 14 (3): 222–8. doi:10.1097/ACI.0000000000000055. PMC 4011631. PMID 24686276.
  8. ↑ 8.0 8.1 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 11.0 11.1 11.2 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.
  12. ↑ 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.
  13. ↑ The Korean Academy of Medical Sciences. Allergic proctocolitis. http://dx.doi.org/10.3346/jkms.2007.22.2.213 Accessed on 31 August, 2016
  14. ↑ 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 |pmid= value (help).
  15. ↑ Libre Pathology. https://librepathology.org/wiki/Eosinophilic_colitis Accessed on September 17, 2016
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