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Allergic bowel disease in children
Medical expert of the article
Last reviewed: 04.07.2025
Early artificial feeding with the introduction of foreign proteins (cow, soy) can lead to the development of food allergies in children, especially those at risk for allergic diseases. Allergic causes of malabsorption syndrome include allergic enterocolitis and enteropathy.
ICD-10 code
K52.9. Noninfectious gastroenteritis and colitis, unspecified.
Pathogenesis
The disease is based on a delayed-type hypersensitivity reaction (IgE-independent). A significant role is assumed for the deficiency of regulatory T-cells with impaired formation of tolerance reactions. Increased permeability of the intestinal wall in allergic enteritis leads to contact of allergens (including bacterial origin) with immunocompetent cells of the lamina propria of the mucous membrane, which provokes the formation of polyvalent sensitization.
Allergic enterocolitis manifests itself in the first month of life in the form of regurgitation syndrome, diarrhea, typical blood in the stool, and a decrease in the rate of physical development. Skin and respiratory symptoms of allergy are possible. The severity of diarrhea in allergic enterocolitis rarely leads to the development of typical malabsorption syndrome.
Allergic enteropathy caused by food sensitization occurs rarely, is more typical for children over 4 months and is accompanied by persistent diarrhea, malnutrition, and vomiting. As with allergic enterocolitis, the causative allergens are milk and soy proteins. Histological examination reveals villous atrophy, infiltration of the proper plate of the mucous membrane by eosinophils, and an increase in the number of interepithelial lymphocytes.
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Diagnostics
In diagnostics, it is important to study the anamnesis. Scarification tests have a greater diagnostic value in case of negative results (they exclude this diagnosis). In case of IgE-mediated reactions, it is informative to determine the titer of specific IgE in the blood: their high content requires the appointment of an elimination diet. The possibility of IgE-independent reactions in enteritis and colitis requires a combination of the above tests with tests that allow diagnosing delayed-type hypersensitivity.
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Treatment
Treatment is an elimination diet. In case of allergy to cow's milk proteins, it is rational to prescribe mixtures based on high-grade protein hydrolysate, but this does not guarantee against the persistence of allergic reactions associated with residual antigenic activity. In this case, amino acid-based nutrition is indicated. Given the complexity of the pathogenesis of the disease, it is not recommended to prescribe products based on other foreign proteins, including soy.