Allergic colitis in babies

How to Recognize Allergic Colitis in Infants

“When you change everything and symptoms don’t go away and blood is still in the stool, further evaluation is needed,” says Rubinstein. Your doctor might suggest a test called a flexible sigmoidoscopy to check the intestines for infection, polyps, or abnormal blood vessels close to the surface that could be causing bleeding. It’s also possible, though not usual, that a baby has a rectal fissure or tear.

It’s still important, though, during this time, to introduce new foods into your child’s diet. Babies need to begin to get used to them, and cereals, for example, contain new vitamins and minerals not found in breast milk or formula.

Allergic Colitis: Managing Baby’s Health

When your infant has allergic colitis, be sure to read food labels to check that what you’re buying for yourself to eat or feed to your baby doesn’t contain cow’s milk, soy, or whatever other protein your infant is allergic to. Don’t assume you know what the contents of a product are. Ingredients and additives change all the time.

Introduce new foods into your baby’s diet first thing in the morning so that if an allergic reaction occurs, you’ll know what caused it. For the same reason, new types of food shouldn’t be introduced more often than every three to five days.

When you change and add foods, involve your pediatrician; see your pediatrician when you need to, but no less than twice after allergic colitis is diagnosed. Your doctor will want to keep track of your baby’s weight and be sure the child is getting all necessary nutrients. At about 11 months, give your baby milk again to see if the allergy has been outgrown.

Elizabeth Marcus, MD, a pediatric gastroenterologist at UCLA Mattel Children’s Hospital in Los Angeles, says allergic colitis is usually resolved relatively quickly. She advised parents to know the signs of allergy, but not to change an infant’s diet without consulting a pediatrician or pediatric gastroenterologist. And Dr. Marcus and Rubinstein both emphasized that parents need not panic.

Discussion

This study showed that evidence of minor immunodeficiency is common in infants with non-infective colitis. In agreement with previous studies we have confirmed that in this age group the commonest cause of non-infective colitis is allergic colitis.1 5 6 9 11 14 15 Ulcerative colitis, non-specific colitis, autoimmune enterocolitis, and severe combined immunodeficiency accounted for only approximately one third of the cases, occurring with the same frequency.

Serum IgG2 and IgG4 deficiency commonly coexisted with deficiencies of IgA, raised IgE or both in this group of infants with colitis.16 17 These immunoglobulins have a role in health in protecting the individual against the uncontrolled absorption of whole proteins and complex antigens from the gastrointestinal lumen. Previous work has shown that the formation of immune complexes, particularly IgA specific immune complexes, may contribute to the release of goblet cell mucus onto the intestinal surface, thus preventing the penetration of antigens or the adherence of infectious agents.18 A deficiency of the serum immunoglobulins may lead to failure of antigen-immunoglobulin complex formation, resulting in intact antigen absorption and sensitisation of the individual. With re-exposure to dietary antigen, minute quantities of allergen may be absorbed and result in allergic symptoms. A vicious cycle of allergic reaction with increased allergen uptake across a disrupted mucosal surface may ensue. Uptake of non-specific intestinal antigen can in turn evoke an IgG mediated reaction which may predispose to chronic disease.19

Increased intestinal permeability, which is a genetically expressed defect that predisposes to the development of inflammatory bowel disease, has been reported.20 One of the genetic defects reported here is probably a deficiency of immunoglobulin A, IgG2, and IgG4 subclasses which predisposes individuals to the absorption of whole antigens, an IgE mediated immunological response, and the release of inflammatory mediators, resulting in an entero- colitis. The inflamed intestinal epithelium allows more antigens to cross the mucosa and the vicious cycle continues.

Anaphylatoxins stimulate macrophages to release prostaglandin E2, thromboxane B2, and leukotriene B4,21 thus initiating and maintaining the inflammatory and tissue damaging process (type 2 and 3 hypersensitivity).

IgG1 secreting plasma cells are the immunocyte class showing by far the greatest expansion in specific inflammatory disease.22 The upregulation of IgG1 is probably a compensatory mechanism that can occur when the other subclasses are low, as seen in these infants.

A family history of atopy is very common in infants with colitis in this and other studies.9-11 14 23 These infants are prone to recurrent infections of the upper respiratory tract, which may be due to the IgG2 and IgG4 subclass deficiency16 as seen in our patients. The finding of a negative intradermal skin prick test in our patients is not unusual, since infants have a poor response to such tests.25

In this series, the T cell function was abnormal in patients with severe combined immunodeficiency, autoimmune enterocolitis, and ulcerative colitis, but largely normal in those with allergic and non-specific colitis. The low CD3 and CD4 T lymphocyte subset population with a raised CD8 in those with SCID probably reflects graft versus host disease (GVHD) due to immunocompetent lymphocytes from the mother. The endoscopic and histological findings in two of these patients were in keeping with GVHD. Those with autoimmune enterocolitis had plasma cell plus lymphocytic infiltration of the lamina propia and the mucosa, with positive smooth muscle and gut autoantibodies.

A third of the infants in this study were exclusively breast fed when they developed colitis. Previous studies in infants fed cows’ milk based formulas from birth have suggested that this group may be at a higher risk of developing allergic colitis. The condition is, however, described in children fed other whole protein milk formulas (soybean) and in infants fed on breast milk.14 24 In this latter group, exclusion of cows’ milk, egg, and soybean products from the maternal diet may alleviate the infant’s symptoms.

The outcome of treatment with exclusion diet alone was excellent in the children in this study with allergic colitis. Infants with other causes of colitis took longer to go into remission, requiring immunosuppression. This group frequently relapsed when intercurrent infections occurred. No case of non-specific colitis went on to develop specific inflammatory bowel disease during follow up within the time course of this study.

We have shown that infants with non-infective colitis commonly have an associated minor immunodeficiency. We suggest that in allergic colitis low levels of IgA, IgG2, and IgG4 might impair the function of mucosal defences against macromolecular passage across the mucosal barrier, thus predisposing to an allergic inflammatory response and mucosal injury. In ulcerative colitis it seems more likely that the minor immunodeficiency alluded to here is a result of an underlying immunodysregulation, although the findings of specific IgE reaginic antibodies to cow’s milk in as many as 30% of children with ulcerative colitis implies that loss of barrier function in these children might also predispose to allergic responses.

In this study population—as in others previously—allergic colitis was the commonest cause of non-infective colitis in infancy and this responded excellently to exclusion diet alone. A positive family and personal history of atopy was common in infants with allergic colitis and in this group the rectum was invariably affected. Macroscopic appearance at endoscopy did not discriminate between normality and allergic colitis, and for this reason mucosal biopsy is considered mandatory to make the diagnosis.

Is colitis in infants caused by their own intestinal flora?

In a project of the Austrian Science Fund an existing explanatory model for the development of a special form of colitis in infants is being called into question. Credit: Dr. Harald Haidl

The existing explanatory model for the development of a special form of colitis in infants is currently being called into question: Whereas it was previously assumed that the cause is an allergic reaction to cow’s milk proteins, there is increasing evidence that an imbalanced intestinal flora is responsible for the blood-streaked stools. In an Austrian Science Fund FWF project, Martin Hoffmann from the Medical University of Graz is now systematically examining this new evidence for the first time.

Distal allergic proctocolitis, as it is known, is an inflammation of the rectum and colon that rarely occurs in infants. The leading symptoms (bloody stools) are alarming for both parents and physicians, although the affected infants appear to be otherwise healthy. It is generally assumed that the cause of the disease is an allergic reaction to cow’s milk proteins. Indeed, in most cases, the inflammation disappears when the infant’s nutrition is changed. But Martin Hoffmann believes there is another cause – and will now investigate this in the context of a systematic study.

Microbiome research

“There are good reasons to assume that a change in the intestinal flora is the true cause of infant proctocolitis”, says the pediatrician, who has already found solid evidence for this hypothesis in initial studies. For instance, preliminary studies in infants with proctocolitis showed the far more frequent occurrence of the bacterium Klebsiella oxytoca. Although this bacterium is known to be able to trigger colitis in connection with treatment with antibiotics, the symptoms are not identical to those for infant proctocolitis. Hoffmann therefore proposes that the bacterium is not the actual cause: “The more frequent occurrence of Klebsiella oxytoca is probably a consequence of an overall change in the intestinal flora, a so-called dysbiosis. If the normal balance of the intestinal flora is upset, harmful bacteria such as Klebsiella oxytoca can run rampant.” The current therapy concept of changing the infant’s nutrition by eliminating cow’s milk would then result in the normalisation of the intestinal flora and not – as previously assumed – in the termination of allergic reactions.

Mounting evidence

Hoffmann’s assumption is, in fact, shared by international colleagues who likewise analysed the composition of the intestinal flora of infants with proctocolitis – and were able to detect clear changes. Further indications that the existing explanatory model of an allergic reaction should be questioned came from studies that searched for specific evidence of allergic reactions – and none could be found.

Clarifying study

To clarify more precisely whether the intestinal flora of infants with proctocolitis is comprehensively altered, an extensive study will now be conducted in Graz using stool samples from up to 130 infants. The study will compare stool samples of infants with and without proctocolitis. One of the challenges for the project is to register all the different types of bacteria. The tool of choice is a genetic method known as 16s-rRNA analysis. This method examines special genetic sections, making it possible to differentiate a broad range of different types of bacteria.

Flexible intestinal flora

Hoffmann explains a further challenge for the project: “In fact, the intestinal flora of children changes naturally over the course of their first year. Against this backdrop, it is difficult to register additional changes due to illness. We will therefore analyse for each child individually how the intestinal flora changes within an eight-week period – and we expect to detect different patterns in the two study groups. That would be a clear indication that a dysbiosis is indeed responsible for the infant proctocolitis.” The confirmation of this hypothesis would then be sufficient reason for Hoffmann to consider a paradigm shift in the explanatory model – and also in the therapy – of cow’s-milk-protein-associated infant proctocolitis.

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Breast milk promotes a different gut flora growth than infant formulas Provided by Austrian Science Fund (FWF) Citation: Is colitis in infants caused by their own intestinal flora? (2015, July 6) retrieved 2 February 2020 from https://medicalxpress.com/news/2015-07-colitis-infants-intestinal-flora.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Ulcerative Colitis

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What Is Ulcerative Colitis?

Ulcerative colitis is a condition that causes the inner lining of the large intestine (colon) to get red and swollen with sores called ulcers. It’s a chronic condition, which means it lasts a long time or constantly comes and goes.

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that happens only in the colon.

What Are the Signs & Symptoms of Ulcerative Colitis?

The most common symptoms of ulcerative colitis are cramping belly pain and diarrhea. Other symptoms include:

  • blood in the toilet, on toilet paper, or in the stool (poop)
  • urgent need to poop
  • a fever
  • low energy
  • weight loss

Ulcerative coliits can cause other problems, such as rashes, eye problems, joint pain and arthritis, and liver disease. Kids with ulcerative colitis may not grow well as well as other kids their age and puberty may happen later than normal.

What Causes Ulcerative Colitis?

The exact cause of ulcerative colitis is not clear. It is probably a combination of genetics, the immune system, and something in the environment that causes inflammation in the gastrointestinal tract. Diet and stress may make symptoms worse, but probably don’t cause ulcerative colitis.

Who Gets Ulcerative Colitis?

Ulcerative colitis tends to run in families. But not everyone with ulcerative colitis has a family history of BD. Ulcerative colitis can happen at any age, but is usually diagnosed in teens and young adults.

How Is Ulcerative Colitis Diagnosed?

Ulcerative colitis is diagnosed with a combination of blood tests, stool tests, and X-rays. Medical imaging tests, such as CT scans and MRIs, might be done too.

The doctor will check the stool for blood, and might look at the colon with an instrument called an endoscope, a long, thin tube attached to a TV monitor. In this procedure, called a colonoscopy, the tube is inserted through the anus to let the doctor see inflammation, bleeding, or ulcers on the wall of the colon. During the procedure, the doctor might do a biopsy (taking small tissue samples for further testing).

How Is Ulcerative Colitis Treated?

Ulcerative colitis is treated with medicines and sometimes surgery. The goal of treatment is to relieve symptoms, prevent other problems, and avoid flare-ups.

The doctor may recommend:

  • anti-inflammatory drugs to decrease the inflammation
  • immunosuppressive agents to prevent the immune system from causing further inflammation
  • biologic agents to block proteins that cause inflammation

Because some medicines make it harder to fight infections, it’s important that your child be tested for tuberculosis and have all the recommended vaccines before starting treatment.

Surgery may be necessary if:

  • the bowel develops a hole
  • the bowel widens and swells up (called toxic megacolon)
  • the bleeding can’t be stopped
  • symptoms don’t respond to treatment

What Else Should I Know About Ulcerative Colitis?

Poor appetite, diarrhea, and poor digestion of nutrients can make it hard for people with ulcerative colitis to get the calories and nutrients the body needs.

Kids and teens with ulcerative colitis should eat a variety of foods, get plenty of fluids, and learn to avoid foods that make symptoms worse. Some may need supplements, like calcium or vitamin D. Kids who are not growing well may need additional nutrition support.

Kids and teens with ulcerative colitis can feel different and might not be able to do the things their friends can do, especially during flare-ups. Some struggle with a poor self-image, depression, or anxiety. They may not take their medicine or follow their diet. It’s important to talk to your health care professional if you’re concerned about your child’s mood, behavior, or school performance.

Parents can help teens with ulcerative colitis take on more responsibility for their health as they get older.

Reviewed by: J. Fernando del Rosario, MD Date reviewed: October 2017

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