Pediatric Gastroenterology Endoscopy and Liver Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
BMC Gastroenterol. 2011 Jul 16;11:82. doi: 10.1186/1471-230X-11-82.
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
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.
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.
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.
仅母乳喂养的婴儿的过敏性直肠结肠炎（APC）是由通过哺乳从母亲饮食中转移而来的食物蛋白引起的。在大多数情况下，母亲的牛奶禁食饮食会迅速缓解直肠出血，而在某些患者中可能会发生多种食物过敏。本研究旨在评估过敏斑贴试验（APT）是否有助于识别因多敏化而需要停止母乳喂养的这组患者。此外，我们还评估了在怀疑存在多种食物过敏时使用氨基酸配方（AAF）的效果。
我们前瞻性地招募了 14 名对母亲过敏原回避治疗有反应的 APC 母乳喂养的婴儿。通过内镜活检确认诊断。进行皮肤点刺试验和常见食物的血清特异性 IgE，以及常见食物加母乳的 APT。在接受 AAF 治疗 1 个月后，所有患者均进行了随访直肠乙状结肠镜检查。
皮肤点刺试验和血清特异性 IgE 均为阴性。APT 在 100%的婴儿中呈阳性，50%的婴儿呈多重阳性。在 100%的婴儿中发现了对母乳的致敏，在 50%的婴儿中发现了对牛奶的致敏，在 28%的婴儿中发现了对大豆的致敏，在 21%的婴儿中发现了对鸡蛋的致敏，在 14%的婴儿中发现了对大米的致敏，在 7%的婴儿中发现了对小麦的致敏。所有婴儿的 APC 随访直肠乙状结肠镜检查均缓解。
这些数据表明，APT 可能成为一种有用的工具，可用于识别涉及延迟免疫机制的多种胃肠道食物过敏的婴儿亚组，目的是在停止母乳喂养之前避免不必要的母亲饮食限制。
