Therapeutic measures include the elimination of the allergen and the appointment of a hypoallergenic diet, the use of antihistamines and anti-inflammatory drugs, enterosorbents, enzymes and membrane stabilizers, and symptomatic treatment of individual manifestations of the disease.
If breastfeeding is carried out, a strict hypoallergenic diet for the mother is necessary, with the exception of potential food allergens and individually intolerable foods. Artificial babies are given special therapeutic mixtures with whey and casein protein hydrolysates, as well as mixtures based on goat milk.
The timing of the introduction of complementary foods to children with allergic enteropathy is postponed until 5-6 months of life, while using hypoallergenic cereals (buckwheat, rice, corn), single-component vegetable puree, meat (veal, horsemeat, pork, rabbit, turkey). Cow milk, cottage cheese, fish and eggs are completely discarded in the first year of life, peanuts are excluded up to three years. Older children and adults follow an individually selected hypoallergenic diet for at least six months.
From antihistamines in the first year of life, the use of dimetinden (in drops), chloropyramine (in tablets), cetirizine (in drops), and ketotifen are recommended. From the year you can use loratadine, and from six years – fexofenadine hydrochloride and ebastine. Enterosorbents are usually applied within one to two weeks during the exacerbation period. According to the indications, enzymes (pancreatin), preparations containing bifidobacteria and lactobacilli, symptomatic agents (defoamers, antiemetic) are prescribed.
Allergic enteropathy (gastrointestinal form of food allergy) – damage to the small intestinal mucosa when allergens enter the gastrointestinal tract. Most often, the disease occurs in young children and is associated with the emergence of hypersensitivity to proteins of cow’s milk, soy and other products used in the introduction of complementary foods and the transition from breastfeeding to artificial.
The prevalence of food allergy among children under the age of 3 years is about 6-8%, in 10-15 years – 3-4%. At the same time, hypersensitivity to cow’s milk protein was detected in 2-2.5% of young children, to chicken protein – in 1-1.5%. As a rule, along with allergic enteropathy, children show signs of allergic damage to other organs and systems (skin, respiratory tract, etc.).
Causes of Allergic Enteropathy
More than 170 products are known that, when penetrated into the gastrointestinal tract, can cause the emergence of a gastrointestinal form of food allergy (allergic enteropathy), and their allergic activity is due to the presence of animal or vegetable proteins, glycoproteins, less often polypeptides.
In children under one year old, allergic enteropathy is in most cases caused by increased sensitivity to cow’s milk protein, which contains more than ten antigens, of which αS1-casein and γ-casein are most active. In children of school age and adults, the development of allergic reactions with intestinal damage is more common when eating protein from chicken eggs, fish and seafood.
The reaction of the immune system often occurs on the plant-derived dietary fiber: wheat, rye, oatmeal, buckwheat and rice groats, soybeans, as well as some vegetables (carrots, celery, tomatoes) and fruits (bananas, citrus fruits).
In the development of food allergies in children and adults, an essential role of genetic predisposition is beyond doubt. This is evidenced by the presence of allergic diseases in relatives of the patient, as well as common patient manifestations of allergies with skin, bronchopulmonary system and the detection of hypersensitivity not only to food, but also to pollen, house dust, medicines and other allergens.
Pathogenesis of allergic enteropathy
In the occurrence of allergic enteropathy plays a role and a decrease in the barrier function of the gastrointestinal tract (due to enzymatic deficiency), impaired IgA production. Allergic reactions that develop during the penetration of food antigens into the gastrointestinal tract can be IgE-mediated, non-IgE-mediated, immunocomplex and cell-mediated.
Allergic intestinal lesions are characterized by non-IgE-mediated (with proctocolitis) and cell-mediated (with allergic enteropathy) reactions.
Symptoms of allergic enteropathy
Gastrointestinal allergy manifests itself as local signs of gastrointestinal lesions (vomiting, intestinal colic, diarrhea), and various extraintestinal manifestations of allergy (atopic dermatitis, eczema, bronchial asthma). The severity of the manifestation of certain clinical symptoms of the disease will differ depending on the age of the patient.
In young children, allergic intestinal damage is manifested by cramping abdominal pains like intestinal colic, regurgitation and vomiting, abdominal distention, and loose stools 5-6 times a day. Occasionally, intestinal bleeding may occur with discoloration of feces. The general condition of the child is disturbed: anxiety, general weakness, paleness of the skin, sleep disturbance, appetite, and hypotrophy appear. Often, allergic enteropathy at this age is accompanied by skin manifestations of the type of atopic dermatitis (dry damaged skin, polymorphic rash).
Timely elimination of the allergen from the diet leads to the cessation of symptoms after 2-3 days. If allergic damage to the gastrointestinal tract is caused by hypersensitivity to cow milk casein, manifestations of enteropathy usually disappear by 2-3 years of life, even with regular consumption of dairy products.
In children of school age, adolescents and adults, the picture of the disease becomes more worn out and is often characterized by dull pain in the navel, flatulence, unstable stools (constipation or diarrhea), decreased appetite, nausea. Extraintestinal manifestations of allergy are rare. At the same time, allergens that cause allergic enteropathy at this age can sometimes be not only food, but also drugs, plant pollen, household dust, etc.
Diagnosis of Allergic Enteropathy
Clinical manifestations of allergic enteropathy are non-specific and occur in gastroenteritis and enterocolitis of various etiologies (including those caused by infectious agents of a viral and bacterial nature, helminths, protozoa, alimentary factors, chemical poisonings, inedible and toxic products).
To establish the correct diagnosis, it is necessary to carefully collect the allergological history, conduct a clinical examination of the patient (consult an allergist-immunologist, gastroenterologist), perform the necessary laboratory and instrumental studies.
Analysis of allergy history reveals the presence of hereditary complications (allergic diseases in relatives). As a rule, a sick child has been observed previously or skin or respiratory allergy symptoms are present at the time of inspection. The appearance of clinical signs of allergic enteropathy (abdominal pain, vomiting, diarrhea) is associated with the ingestion of a food allergen (cow’s milk, eggs, fish, peanuts, etc.). The condition improves significantly after the exclusion of the problem food from the diet.
Prognosis and prevention of allergic enteropathy
Switching to an elimination diet leads to a regression of the symptoms of enteropathy. Serious health effects do not usually develop.
Prevention of allergic enteropathy consists in adherence of a hypoallergenic diet to a pregnant and nursing mother, breastfed up to 4-6 months of life, introduction of complementary foods to the child no earlier than the fourth month of life, elimination from the diet of potential allergens in older children and in adults.