식품 단백질 유발성 직결장염의 임상 소견과 식이 조절에 관한 연구
Clinical Features and the Natural History of Dietary Protein Induced Proctocolitis: a Study on the Elimination of Offending Foods from the Maternal Diet
0
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Purpose: The aim of this study was to identify the clinical features and natural history of dietary protein induced proctocolitis (DPIPC) and to detect the causative foods of DPIPC, and to evaluate the effect of elimination of the foods on the course of the disease. Methods: Between March 2003 and July 2004, data from 30 consecutive patients with DPIPC who were followed for over 6 months, was reviewed. The diagnostic criterion used for DPIPC was an increase in the number of eosinophils in the lamina propria (≥60 per 10 high-power fields). In breast feeding mothers, 5 highly allergenic foods were eliminated from the maternal diet for 7 days, namely, allergenic food groups such as dairy products, eggs, nuts and soybean, fish and shellfish, and wheat and buckwheat. We observed the disappearance or appearance of hematochezia after elimination or challenge with the offending foods. Results: Before diagnosis infants were breast-fed (93.3%) or formula-fed (6.7%). Mean age at symptom onset was 11.5±5.1 (5～24) weeks, and mean age at diagnosis was 17.8±9.5 (8～56) weeks. Duration from symptom onset to diagnosis was 6.3±6.7 (0～36) weeks. Mean peripheral blood eosinophil count was 478±320 (40～1,790)/mm3 and eosinophilia (＞250/mm3) was observedin90.0% of patients. None of patients were found to have an increased serum IgE level. Of 15 patients that received sigmoidoscopy, nodular hyperplasia with erosion was observed in 93.3%. Of 27 patients whose mother ate the diet eliminated the 5 food groups, hematochezia diappeared in 74.1% of patients. Offending foods were identified as dairy products (37.5%), wheat and buckwheat (27.5%), fish and shellfish (20.0%), nuts and soybean (7.5%) and eggs (7.5%). A free maternal diet without patient's clinical symptoms was achieved at 29.4±8.7 (9～44) weeks of patient's age, and a free baby diet without blood in stools was achieved at 37.5±9.7 (12～56) weeks of age. Conclusion: DPIPC commonly occurs in exclusively breast-fed babies. Elimination of the above- mentioned 5 hyper-allergenic food groups from the maternal diet for 7days enables the detection of the offending foods. DPIPC is a transient disorder and 96.0% of patients can tolerate the offending foods at 12 months of age. (Korean J Pediatr Gastroenterol Nutr 2005; 8: 21～30)
Abstract
Purpose: The aim of this study was to identify the clinical features and natural history of dietary protein induced proctocolitis (DPIPC) and to detect the causative foods of DPIPC, and to evaluate the effect of elimination of the foods on the course of the disease. Methods: Between March 2003 and July 2004, data from 30 consecutive patients with DPIPC who were followed for over 6 months, was reviewed. The diagnostic criterion used for DPIPC was an increase in the number of eosinophils in the lamina propria (≥60 per 10 high-power fields). In breast feeding mothers, 5 highly allergenic foods were eliminated from the maternal diet for 7 days, namely, allergenic food groups such as dairy products, eggs, nuts and soybean, fish and shellfish, and wheat and buckwheat. We observed the disappearance or appearance of hematochezia after elimination or challenge with the offending foods. Results: Before diagnosis infants were breast-fed (93.3%) or formula-fed (6.7%). Mean age at symptom onset was 11.5±5.1 (5～24) weeks, and mean age at diagnosis was 17.8±9.5 (8～56) weeks. Duration from symptom onset to diagnosis was 6.3±6.7 (0～36) weeks. Mean peripheral blood eosinophil count was 478±320 (40～1,790)/mm3 and eosinophilia (＞250/mm3) was observedin 90.0% of patients. None of patients were found to have an increased serum IgE level. Of 15 patients that received sigmoidoscopy, nodular hyperplasia with erosion was observed in 93.3%. Of 27 patients whose mother ate the diet eliminated the 5 food groups, hematochezia diappeared in 74.1% of patients. Offending foods were identified as dairy products (37.5%), wheat and buckwheat (27.5%), fish and shellfish (20.0%), nuts and soybean (7.5%) and eggs (7.5%). A free maternal diet without patient's clinical symptoms was achieved at 29.4±8.7 (9～44) weeks of patient's age, and a free baby diet without blood in stools was achieved at 37.5±9.7 (12～56) weeks of age. Conclusion: DPIPC commonly occurs in exclusively breast-fed babies. Elimination of the above- mentioned 5 hyper-allergenic food groups from the maternal diet for 7days enables the detection of the offending foods. DPIPC is a transient disorder and 96.0% of patients can tolerate the offending foods at 12 months of age. (Korean J Pediatr Gastroenterol Nutr 2005; 8: 21～30)
참고문헌 (22)
- Sampson HA, "Summary and recommendations:classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children", 30(1), pp.87~94 (2000)
- 황진복, "새로운 분류법에 따른 소아 위장관 우유 알레르기 질환에 관한 임상적 고찰", Pediatric Gastroenterology, Hepatology & Nutrition, 7(1), pp.40~47 (2004), 대한소아소화기영양학회
- 김재복, "영아 알레르기성 대장염의 임상 및 병리학적 고찰", 41, pp.521~8 (1998)
- Kumar D, "Allergic colitis presenting in the first day of life:report of three cases", 31, pp.195~7 (2000)
- D'Netto MA, "Allergic gastroenteropathy in preterm infants", 137, pp.480~6 (2000)
- Swart JF, "Rectal bleeding in a preterm infant as a symptom of allergic colitis", 162, pp.55~6 (2003)
- Pumberger W, "Proctocolitis in breast fed infants:a contribution to differential diagnosis of haematochezia in early childhood", 77, pp.252~4 (2001)
- Odze RD, "Allergic colitis in infants", 126, pp.163~70 (1995)
- 김세훈, "알레르기 증상으로 내원한 한국인에서의 음식물 알레르겐에 대한 감작율 조사: 다기관 공동연구", 천식 및 알레르기, 23(3), pp.502~514 (2003), 대한천식알레르기학회
- Odze RD, "Allergic proctocolitis in infants:a prospective clinical-pathologic biopsy study", 24, pp.668~74 (1993)
- Lifschitz CH, "Anaphylatic shock due to cow's milk protein hypersensitivity in a breast-fed infant", 7, pp.141~4 (1988)
- Arvola T, "Weaning to hypoallergenic formula improves gut barrier function in breast-fed infants with atopic eczema", 38, pp.92~6 (2004)
- Feiterna-Sperling C, "A case of cow's milk allergy in the neonatal period - evidence for intrauterine sensitization", 8, pp.153~5 (1997)
- Lake AM, "Dietary protein-induced colitis in breast-fed infants", 101, pp.906~10 (1982)
- Sicherer S, "Food allergy", 360, pp.701~10 (2002)
- Glassman MS, "Cow milk protein sensitivity during infancy in patients with inflammatory bowel disease", 85, pp.838~40 (1990)
- Catlett JB, "Ulcerative colitis in an allergic person:case report", 115, pp.434~5 (1988)
- Machida HM, "Allergic colitis in infancy:clinical and pathological aspects", 19, pp.22~6 (1994)
- Dupont C, "Rectosigmoidoscopic findings during isolated rectal bleeding in the neonate", 6, pp.257~64 (1987)
- Gottrand F, "Food-induced bleeding from lymphonodular hyperplasia of the colon", 147, pp.821~3 (1993)
- Thomas DW, "Rectal mucosal major basic protein in infants with dietary protein-induced colitis", 71, pp.66~9 (1993)
- Rothenberg ME, "Eosinophilic gastrointestinal disorders", 113, pp.11~28 (2004)