The allergic enteropatiya is the inflammatory disease of a small intestine of the allergic nature arising at penetration into an organism of the anti-genes causing the excessive, increased reaction of immune system. Most often the disease develops at children of early age. The allergic enteropatiya is shown by diarrhea, an abdominal distension, intestinal gripes, vomiting, an insufficient increase of weight. Diagnostics includes survey of the pediatrician and allergist-immunologist, carrying out laboratory analyses and allergologichesky tests, an intestines research. Treatment consists in the termination of contact with allergen, purpose of a hypoallergenic diet, antihistamines.
Allergic enteropatiya (gastrointestinalny form of food allergy) – damage of a mucous membrane of a small intestine at hit in digestive tract of allergens. Most often the disease arises at children of early age and is connected with emergence of hypersensibility to proteins of cow's milk, the soy and other products used at introduction of a feeding up and transition from breastfeeding to artificial.
Prevalence of food allergy among children under 3 years makes about 6-8%, in 10-15 years – 3-4%. At the same time hypersensibility to protein of cow's milk is revealed at 2-2,5% of children of early age, to chicken protein – at 1-1,5%. As a rule, along with an allergic enteropatiya at children signs of allergic defeat of other bodies and systems are noted (integuments, airways, etc.).
More than 170 products which at penetration into digestive tract are capable to cause emergence of a gastrointestinalny form of food allergy (an allergic enteropatiya) are known, and their allergic activity is caused by availability of animal or vegetable proteins, glikoproteid, is more rare than polypeptides.
At children aged about one year the allergic enteropatiya is in most cases caused by hypersensibility to protein of cow's milk which contains more than ten anti-genes from which have the greatest activity αS1- and γ-casein. At children of school age and adults development of allergic reactions meets with damage of intestines at the use of protein of egg, fish and seafood more often. Reaction of immune system quite often arises on the food fibers of a phytogenesis coming to an organism: wheat, rye, oat, buckwheat and rice grain, soy, and also some vegetables (carrots, celery, tomatoes) and fruit (bananas, citrus).
In development of food allergy in children and adults the essential role of hereditary predisposition is undoubted. Presence of allergic diseases at the patient's relatives, and also the general displays of an allergy which are often found at the patient with damage of skin, bronchopulmonary system and detection of hypersensibility not only to foodstuff, but also to pollen of plants, house dust, medicines and other allergens testifies to it.
In emergence of an allergic enteropatiya plays a role and decrease in the GIT barrier function (because of enzymatic insufficiency), IgA development violation. The allergic reactions developing at penetration into digestive tract of food anti-genes can be IgE-mediated, not-IgE-mediated, immunocomplex and cellular mediated. Are characteristic of allergic damage of intestines not-IgE-mediated (at a proktokolita) and cellular mediated (at an allergic enteropatiya) reactions.
Symptoms of an allergic enteropatiya
The Gastrointestinalny allergy is shown as local signs of damage of digestive tract (vomiting, intestinal colic, diarrhea), and various extra intestinal displays of an allergy (atopic dermatitis, eczema, bronchial asthma). Expressiveness of manifestation of these or those clinical symptoms of a disease will differ depending on age of the patient.
At children of early age allergic damage of intestines is shown by skhvatkoobrazny belly-aches as intestinal colic, vomiting and vomiting, an abdominal distension, a liquid chair of 5-6 times a day. There can sometimes be intestinal bleedings with change of color a calla. The general condition of the child is broken: there is a concern, the general weakness, pallor of integuments, frustration of a dream, appetite, a hypotrophy. Quite often allergic enteropatiya at this age is followed by skin manifestations as atopic dermatitis (the dry injured skin, polymorphic rash).
Timely elimination of allergen from a diet leads to the termination of symptomatology in 2-3 days. If allergic damage of a GIT is caused by hypersensibility to casein of cow's milk, manifestations of an enteropatiya usually disappear by 2-3 year of life even at the regular use of dairy products.
At children of school age, teenagers and adults the picture of a disease becomes more erased and is characterized more often by dull aches in a navel, a meteorizm, an unstable chair (locks or ponosa), a loss of appetite, nausea. Extra intestinal displays of an allergy meet infrequently. At the same time not only foodstuff, but also medicamentous means, pollen of plants, household dust etc. can sometimes be the allergens causing an allergic enteropatiya at this age.
Clinical manifestations of an allergic enteropatiya are not specific and meet at a gastroenteritis and enterokolita of various etiology (including, caused by infectious agents of the virus and bacterial nature, helminths, the elementary, alimentary factors, poisonings with chemicals, inedible and poisonous products). To establish the correct diagnosis, it is necessary to collect carefully the allergologichesky anamnesis, to perform clinical examination of the patient (consultation of the allergist-immunologist, gastroenterologist), to execute necessary laboratory and tool researches.
The analysis of the allergologichesky anamnesis allows to reveal existence of a hereditary otyagoshchennost (allergic diseases at relatives). As a rule, at the sick child were observed earlier or there are at the time of survey skin or respiratory symptoms of an allergy. Emergence of clinical signs of an allergic enteropatiya (belly-aches, vomiting, diarrhea) is connected with receipt in an organism of food allergen (cow's milk, eggs, fish, a peanut and so forth). The state considerably improves after an exception of problem foodstuff of a diet.
At a laboratory research in the general blood test the eozinofiliya (increase in quantity of eosinophils) is found. The analysis the calla (koprogramma) allows to reveal the increased maintenance of erythrocytes, eosinophils, neutrophils. The histologic research of bioptat mucous a small intestine finds inflammation signs (hypostasis and hemorrhages), infiltration of own plate lymphocytes, corpulent and plasmatic cages. In some cases the partial atrophy of fibers comes to light. When carrying out a specific allergologichesky research the maintenance of the general IgE, and also specific IgE and IgG is defined, skin allergoproba with a set of food allergens are used,
Differential diagnostics at an allergic enteropatiya is carried out, first of all, with a gluten enteropatiya at which there are no extra intestinal displays of an allergy, antigliadinovy IgA-antibodies and antibodies to a transglutaminaza are found.
Treatment of an allergic enteropatiya
Medical actions include elimination of allergen and purpose of a hypoallergenic diet, application antihistaminic and resolvents, enterosorbents, enzymes and membranostabilizator, symptomatic treatment of separate displays of a disease.
If breastfeeding is carried out, drawing up a strict hypoallergenic diet is necessary for mother with an exception of potential food allergens and individually intolerable products. To the children who are on artificial feeding special medical mixes with serumal and casein proteinaceous hydrolyzates, and also mixes on the basis of goat milk are appointed. The time of introduction of a feeding up to children with an allergic enteropatiya is postponed to 5-6 months of life, at the same time hypoallergenic porridges (buckwheat, rice, corn), mononuclear vegetable purees, meat (veal, a horse-flesh, pork, a rabbit, a turkey) are used. On the first year of life completely refuse cow's milk, cottage cheese, fish and eggs, exclude a peanut up to three years. Children of advanced age and adults keep to individually picked up hypoallergenic diet for not less than six months.
From antihistamines on the first year of life use of a dimetinden (in drops), a hloropiramina (in tablets), a tsetirizina (in drops), and also a ketotifena is recommended. Since a year it is possible to use , and since six years – a feksofenadin a hydrochloride and . Enterosorbents it is, as a rule, applied within one-two weeks in the period of an aggravation. According to indications enzymes (Pancreatinum), the medicines containing bifido-and lactobacilli, symptomatic means are appointed (defoaming agents, antiemetic).
Forecast and prevention
Transition to an eiminatsionny diet leads to regress of symptoms of an enteropatiya. Serious consequences for health usually do not develop. Prevention of an allergic enteropatiya consists in observance of the pregnant woman and the nursing mother of a hypoallergenic diet, breastfeeding to 4-6 months of life, introduction of a feeding up to the child not earlier than the fourth month of life, an exception of a diet of potential allergens at more advanced age and at adults.