Compartilhar
Informação da revista
Vol. 90. Núm. 1.
Páginas 16-21 (Janeiro - Fevereiro 2014)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Vol. 90. Núm. 1.
Páginas 16-21 (Janeiro - Fevereiro 2014)
ARTIGO DE REVISÃO
DOI: 10.1016/j.jpedp.2013.03.008
Open Access
Eosinophilic colitis in infants
Colite eosinofílica em lactentes
Visitas
2783
Adriana Chebar Lozinsky, Mauro Batista de Morais
Autor para correspondência
maurobmorais@gmail.com

Corresponding author.
Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Informação do artigo
Resume
Bibliografia
Baixar PDF
Estatísticas
Abstract
Objective

To review the literature for clinical data on infants with allergic or eosinophilic colitis.

Data source

MEDLINE search of all indexes was performed using the words “colitis or procto-colitis and eosinophilic” or “colitis or proctocolitis and allergic” between 1966 and February of 2013. All articles that described patients’ characteristics were selected.

Data synthesis

A total of 770 articles were identified, of which 32 met the inclusion criteria. The 32 articles included a total of 314 infants. According to the available information, 61.6% of infants were male and 78.6% were younger than 6 months. Of the 314 patients, 49.0% were fed exclusively breast milk, 44.2% received cow's milk protein, and 6.8% received soy protein. Diarrheal stools were described in 28.3% of patients. Eosinophilia was found in 43.8% (115/263) of infants. Colonic or rectal biopsy showed infiltration by eosinophils (between 5 and 25 perhigh-power field) in 89.3% (236/264) of patients. Most patients showed improvement with theremoval of the protein in cow's milk from their diet or the mother's diet. Allergy challenge tests with cow's milk protein were cited by 12 of the 32 articles (66 patients).

Conclusions

Eosinophilic colitis occurs predominantly in the first six months of life and in males. Allergy to cow's milk was considered the main cause of eosinophilic colitis. Exclusion of cow'smilk from the diet of the lactating mother or from the infant's diet is generally an effective therapeutic measure.

Keywords:
Colitis
Milk hypersensitivity
Eosinophils
Infant
Resumo
Objetivo

Revisão da literatura sobre dados clínicos de lactentes com colite eosinofílica oualérgica.

Fonte dos dados

Pesquisa no Medline de todas as indexações com as palavras “colitis or proc-tocolitis and eosinophilic” ou “colitis or proctocolitis and allergic” entre 1966 e fevereiro de 2013. Foram selecionados todos os artigos que descreviam as características dos pacientes.

Síntese dos dados

Foram identificados 770 artigos dos quais 32 preenchiam os critérios de inclusão. Os 32 artigos incluíram o total de 314 lactentes. Conforme as informações disponíveis, 61,6% dos lactentes eram do sexo masculino e 78,6% apresentavam idade inferior a 6 meses. Dos 314 pacientes, 49,0% encontrava-se em aleitamento natural exclusivo, 44,2% recebiam proteína do leite de vaca e 6,8% proteína da soja. Fezes diarreicas foram descritas em 28,3% dos pacientes. Eosinofilia foi encontrada em 43,8% (115/263) dos lactentes. Biópsia retal ou colônica mostrou infiltração por eosinófilos (entre 5 e 25 por campo de grande aumento) em 89,3% (236/264) dos pacientes. A maio- ria dos pacientes apresentou melhora com a retirada da proteína do leite de vaca da sua dieta ou das suas mães. Teste de desencadeamento com proteína do leite de vaca foi citado em 12 dos 32 artigos (66 pacientes).

Conclusões

Colite eosinofílica ocorre predominantemente nos primeiros seis meses de vida e no sexo masculino. Alergia ao leite de vaca foi considerada a principal causa de colite eosinofílica. Dieta de exclusão do leite de vaca da mãe lactante ou da dieta do lactente é uma medidate rapêutica geralmente eficaz.

Palavras-chave:
Colite
Alergia a leite
Eosinófilos
Lactente
O texto completo está disponível em PDF
Referências
[1]
M.S. Toporovski.
Pediatricians and nutritionists knowledge about treatment of cow milk allergy in infants.
Rev Paul Ped., 25 (2007), pp. 104-105
[2]
R. Meyer.
New guidelines for managing cow's milk allergy in infants.
J Fam Health Care., 18 (2008), pp. 27-30
[3]
C.K. Naspitz, D. Solé, C.A. Jacob, E. Sarinho, F.J. Soares, V. Dantas, et al.
Sensibilização a alérgicos inalantes e alimentares em crianças brasileiras atópicas, pela determinação in vitro de IgE total e específica. Projeto Alergia (PROAL).
J Pediatr (Rio J)., 80 (2004), pp. 203-210
[4]
A. Høst.
Frequency of cow's milk allergy in childhood.
Ann Allergy Asthma Immunol., 89 (2002), pp. 33-37
[5]
J. Maloney, A. Nowak-Wegrzyn.
Educational clinical case series for pedia- tric allergy and immunology: allergic proctocolitis, food protein-indu- ced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy.
Pediatr Allergy Immunol., 18 (2007), pp. 360-367
[6]
M.C. Vieira, M.B. Morais, J.V. Spolidoro, M.S. Toporovski, A.L. Cardoso, G.T. Araujo, et al.
A survey on clinical presentation and nutritional status of infants with suspected cow's milk allergy.
BMC Pediatr., 10 (2010), pp. 25
[7]
L.C. Medeiros, P.G. Speridião, V.L. Sdepanian, U. Fagundes-Neto, M.B. Morais.
Ingestão de nutrientes e estado nutricional de crianças em dieta isenta de leite de vaca e derivados.
J Pediatr (Rio J)., 80 (2004), pp. 363-370
[8]
J. Walker-Smith.
An eye witness perspective of the changing patterns of food allergy.
Eur J Gastroenterol Hepatol., 17 (2005), pp. 1313-1316
[9]
S. Koletzko, B. Niggemann, A. Arato, J.A. Dias, R. Heuschkel, S. Husby, et al.
Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines.
J Pediatr Gastroenterol Nutr., 55 (2012), pp. 221-229
[10]
N. Okpara, B. Aswad, G. Baffy.
Eosinophilic colitis.
World J Gastroenterol., 15 (2009), pp. 2975-2979
[11]
W.B. Gaertner, J.E. Macdonald, M.R. Kwaan, C. Shepela, R. Madoff, J. Jessurun, et al.
Eosinophilic colitis: university of Minnesota experience and literature review.
Gastroenterol Res Pract., 2011 (2011), pp. 857508
[12]
A.M. Lake, P.F. Whitington, S.R. Hamilton.
Dietary protein-induced colitis in breast-fed infants.
J Pediatr., 101 (1982), pp. 906-910
[13]
M.P. Sherman, K.L. Cox.
Neonatal eosinophilic colitis.
J Pediatr., 100 (1982), pp. 587-589
[14]
H.R. Jenkins, J.R. Pincott, J.F. Soothill, P.J. Milla, J.T. Harries.
Food allergy: the major cause of infantile colitis.
Arch Dis Child., 59 (1984), pp. 326-329
[15]
H. Goldman, R. Proujansky.
Allergic proctitis and gastroenteritis in children. Clinical and mucosal biopsy features in 53 cases.
Am J Surg Pathol., 10 (1986), pp. 75-86
[16]
V.N. Perisic, D. Filipovic, G. Kokai.
Allergic colitis with rectal bleeding in an exclusively breast-fed neonate.
Acta Paediatr Scand., 77 (1988), pp. 163-164
[17]
S. Berezin, S.M. Schwarz, M. Glassman, M. Davidian, L.J. Newman.
Gastroin- testinal milk intolerance of infancy.
Am J Dis Child., 143 (1989), pp. 361-362
[18]
S.M. Hill, P.J. Milla.
Colitis caused by food allergy in infants.
Arch Dis Child., 65 (1990), pp. 132-133
[19]
K. Pittschieler.
Cow's milk protein-induced colitis in the breast-fed infant.
J Pediatr Gastroenterol Nutr., 10 (1990), pp. 548-549
[20]
C.J. Harrison, J.W. Puntis, G.M. Durbin, P. Gornall, I.W. Booth.
Atypical allergic colitis in preterm infants.
Acta Paediatr Scand., 80 (1991), pp. 1113-1116
[21]
R.D. Odze, J. Bines, A.M. Leichtner, H. Goldman, D.A. Antonioli.
Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study.
Hum Pathol., 24 (1993), pp. 668-674
[22]
H.M. Machida, A.G. Catto Smith, D.G. Gall, C. Trevenen, R.B. Scott.
Allergic colitis in infancy: clinical and pathologic aspects.
J Pediatr Gastroenterol Nutr., 19 (1994), pp. 22-26
[23]
L. Anveden-Hertzberg, Y. Finkel, B. Sandstedt, B. Karpe.
Proctocolitis in exclusively breast-fed infants.
Eur J Pediatr., 155 (1996), pp. 464-467
[24]
D.A. Bloom, C. Buonomo, S.J. Fishman, G. Furuta, S. Nurko.
Allergic colitis: a mimic of Hirschsprung disease.
Pediatr Radiol., 29 (1999), pp. 37-41
[25]
D. Kumar, A. Repucci, J. Wyatt-Ashmead, G. Chelimsky.
Allergic colitis presenting in the first day of life: report of three cases.
J Pediatr Gastroenterol Nutr., 31 (2000), pp. 195-197
[26]
Y. Patenaude, C. Bernard, R. Schreiber, A.B. Sinsky.
Cow's-milk-induced allergic colitis in an exclusively breast-fed infant: diagnosed with ultrasound.
Pediatr Radiol., 30 (2000), pp. 379-382
[27]
W. Pumberger, G. Pomberger, W. Geissler.
Proctocolitis in breast fed in- fants: a contribution to differential diagnosis of haematochezia in early childhood.
Postgrad Med J., 77 (2001), pp. 252-254
[28]
N.J. Diaz, F.S. Patricio, U. Fagundes-Neto.
Allergic colitis: clinical and morphological aspects in infants with rectal bleeding.
Arq Gastroenterol., 39 (2002), pp. 260-267
[29]
S. Sorea, A. Dabadie, L. Bridoux-Henno, M. Balançon-Morival, H. Jouan, E. Le Gall.
Hemorrhagic colitis in exclusively breast-fed infants.
Arch Pediatr., 10 (2003), pp. 772-775
[30]
J.F. Swart, K. Ultee.
Rectal bleeding in a preterm infant as a symptom of allergic colitis.
Eur J Pediatr., 162 (2003), pp. 55-56
[31]
M.R. Faber, P. Rieu, B.A. Semmekrot, J.H. Van Krieken, J.J. Tolboom, J.M. Draaisma.
Allergic colitis presenting within the first hours of premature life.
Acta Paediatr., 94 (2005), pp. 1514-1515
[32]
S.A. Xanthakos, J.B. Schwimmer, H. Melin-Aldana, M.E. Rothenberg, D.P. Witte, M.B. Cohen.
Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study.
J Pediatr Gastroenterol Nutr., 41 (2005), pp. 16-22
[33]
T. Arvola, T. Ruuska, J. Keränen, H. Hyöty, S. Salminen, E. Isolauri.
Rectal bleeding in infancy: clinical, allergological, and microbiological examination.
Pediatrics., 117 (2006), pp. e760-e768
[34]
C. Sierra Salinas, J. Blasco Alonso, L. Olivares Sánchez, A. Barco Gálvez, L. del Río Mapelli.
Allergic colitis in exclusively breast-fed infants.
An Pediatr (Barc)., 64 (2006), pp. 158-161
[35]
Y. Ohtsuka, T. Shimizu, H. Shoji, T. Kudo, T. Fujii, M. Wada, et al.
Neonatal transient eosinophilic colitis causes lower gastrointestinal bleeding in early infancy.
J Pediatr Gastroenterol Nutr., 44 (2007), pp. 501-505
[36]
M.E. Baldassarre, N. Laforgia, M. Fanelli, A. Laneve, R. Grosso, C. Lifschitz, G.G. Lactobacillus.
improves recovery in infants with blood in the stools and presumptive allergic colitis compared with extensively hydrolyzed formula alone.
J Pediatr., 156 (2010), pp. 397-401
[37]
A. Cseh, K. Molnár, P. Pintér, B. Szalay, B. Szebeni, A. Treszl, et al.
Regulatory T cells and T helper subsets in breast-fed infants with hematochezia caused by allergic colitis.
J Pediatr Gastroenterol Nutr., 51 (2010), pp. 675-677
[38]
Y. Yamada, A. Nishi, Y. Ebara, M. Kato, H. Yamamoto, H. Morita, et al.
Eosinophilic gastrointestinal disorders in infants: a Japanese case series.
Int Arch Allergy Immunol., 155 (2011), pp. 40-45
[39]
S. Lucarelli, G. Di Nardo, G. Lastrucci, Y. D’Alfonso, A. Marcheggiano, T. Federici, et al.
Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation.
BMC Gastroenterol., 11 (2011), pp. 82
[40]
A. Fretzayas, M. Moustaki, K.N. Priftis, A. Attilakos, E. Lapa, P. Nicolaidou.
Thrombocytosis as an overt sign of cow's milk allergic proctocolitis.
Allergol Immunopathol (Madr)., 39 (2011), pp. 381-383
[41]
Y. Ohtsuka, K. Jimbo, E. Inage, M. Mori, Y. Yamakawa, Y. Aoyagi, et al.
Microarray analysis of mucosal biopsy specimens in neonates with rectal bleeding: is it really an allergic disease?.
J Allergy Clin Immunol., 129 (2012), pp. 1676-1678
[42]
M.E. Baldassarre, A. Cappiello, N. Laforgia, J. Vanderhoof.
Allergic colitis in monozygotic preterm twins.
Immunopharmacol Immunotoxicol., 35 (2013), pp. 198-201
[43]
S. Behjati, M. Zilbauer, R. Heuschkel, A. Phillips, C. Salvestrini, F. Torrente, et al.
Defining eosinophilic colitis in children: insights from a retrospec- tive case series.
J Pediatr Gastroenterol Nutr., 49 (2009), pp. 208-215
[44]
J. Boné, A. Claver, I. Guallar, A.M. Plaza.
Allergic proctocolitis, food- induced enterocolitis: immune mechanisms, diagnosis and treatment.
Allergol Immunopathol (Madr)., 37 (2009), pp. 36-42
[45]
M.B. Morais, P.G. Speridião, M.D. Sillos, C.C. Ribeiro.
Allergy to cow's milk protein.
Pediatr Mod., 46 (2010), pp. 165-182
[46]
P.J. Kilshaw, A.J. Cant.
The passage of maternal dietary proteins into human breast milk.
Int Arch Allergy Appl Immunol., 75 (1984), pp. 8-15
[47]
Academy of Breastfeeding Medicine. ABM Clinical Protocol #24: allergic proctocolitis in the exclusively breastfed infant. Breastfeed Med. 2011;6:435-40.
[48]
S.A. Bock.
Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life.
Pediatrics., 79 (1987), pp. 683-688
[49]
Diagnostic criteria for food allergy with predominantly intestinal symptoms. The European Society for Paediatric Gastroenterology and Nutrition Working Group for the Diagnostic Criteria for Food Allergy. J Pediatr Gastroenterol Nutr. 1992;14:108-12.

Como citar este artigo: Lozinsky AC, Morais MB. Eosinophilic colitis in infants. J Pediatr (Rio J). 2014;90:16-21.

Copyright © 2013. Brasileira de Pediatria
Idiomas
Jornal de Pediatria

Receba a nossa Newsletter

Opções de artigo
Ferramentas
en pt
Taxa de publicaçao Publication fee
Os artigos submetidos a partir de 1º de setembro de 2018, que forem aceitos para publicação no Jornal de Pediatria, estarão sujeitos a uma taxa para que tenham sua publicação garantida. O artigo aceito somente será publicado após a comprovação do pagamento da taxa de publicação. Ao submeterem o manuscrito a este jornal, os autores concordam com esses termos. A submissão dos manuscritos continua gratuita. Para mais informações, contate assessoria@jped.com.br. Articles submitted as of September 1, 2018, which are accepted for publication in the Jornal de Pediatria, will be subject to a fee to have their publication guaranteed. The accepted article will only be published after proof of the publication fee payment. By submitting the manuscript to this journal, the authors agree to these terms. Manuscript submission remains free of charge. For more information, contact assessoria@jped.com.br.
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.