Allergic colitis laboratory findings: Difference between revisions
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{{Allergic colitis}} | {{Allergic colitis}} | ||
{{CMG}}; {{AE}}{{QS}} | {{CMG}}; {{AE}}{{QS}} | ||
==Overview== | ==Overview== | ||
There are no specific laboratory findings that are pathognomonic of allergic colitis. Laboratory studies should therefore be correlated with a carefully taken history and a detailed physical examination. Presence of [[eosinophil]]s in the stool is suggestive of allergic colitis in the presence of typical clinical findings. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
There are specific diagnostic laboratory findings associated with allergic colitis. | There are no specific diagnostic laboratory findings associated with allergic colitis. Laboratory studies should therefore be correlated with a carefully taken history and a detailed physical examination.<ref name="pmid20618740">{{cite journal| author=Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K et al.| title=World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. | journal=Pediatr Allergy Immunol | year= 2010 | volume= 21 Suppl 21 | issue= | pages= 1-125 | pmid=20618740 | doi=10.1111/j.1399-3038.2010.01068.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20618740 }} </ref><ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref> | ||
===Stool microscopy=== | |||
*Presence of [[blood in stool|blood]], either frank or [[occult blood]] | |||
*May show increased [[eosinophil]]s, which is suggestive of allergic colitis in the presence of typical clinical findings and absence of [[ova]] and [[parasites]] | |||
===Complete Blood Count with Differentials and Peripheral Blood Smear=== | |||
*A low [[hemoglobin]] or [[hematocrit]] with microcytosis or marginal normocytosis may be observed and is indicative of [[iron deficiency anemia]] from [[blood loss]] | |||
*Peripheral blood [[eosinophilia]] may rarely be observed in FPIES | |||
*Elevated [[white blood cells]] with a [[left shift]] may be observed in severe acute FPIES | |||
===Iron studies=== | |||
*Low [[ferritin]] with a high [[TIBC]] is suggestive of [[chronic blood loss]] by [[inflammatory bowel disease]] | |||
*High [[ferritin]] may be suggestive of [[anemia]] of chronic inflammatory conditions | |||
===Complete Metabolic Panel=== | |||
*May demonstrate [[hypoalbuminemia]], especially in children with chronic FPIES | |||
*[[Metabolic acidosis]] may be observed in FPIES | |||
===Other tests=== | |||
*[[Methemoglobinemia]] may be observed in severe acute FPIES<ref name="pmid24686276">{{cite journal| author=Feuille E, Nowak-Węgrzyn A| title=Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. | journal=Curr Opin Allergy Clin Immunol | year= 2014 | volume= 14 | issue= 3 | pages= 222-8 | pmid=24686276 | doi=10.1097/ACI.0000000000000055 | pmc=4011631 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24686276 }} </ref> | |||
*Serum [[IgE]] test against the offending food protein is usually negative | |||
*[[ANCA|Atypical-pANCA antibodies of IgG]] may be observed in some patients. This is not pathognomonic of allergic colitis. | |||
*[[Atopy]] patch test (APT), although not recommended presently for diagnosis of allergic colitis, may be useful to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism.<ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue= | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 16:26, 1 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]
Overview
There are no specific laboratory findings that are pathognomonic of allergic colitis. Laboratory studies should therefore be correlated with a carefully taken history and a detailed physical examination. Presence of eosinophils in the stool is suggestive of allergic colitis in the presence of typical clinical findings.
Laboratory Findings
There are no specific diagnostic laboratory findings associated with allergic colitis. Laboratory studies should therefore be correlated with a carefully taken history and a detailed physical examination.[1][2][3]
Stool microscopy
- Presence of blood, either frank or occult blood
- May show increased eosinophils, which is suggestive of allergic colitis in the presence of typical clinical findings and absence of ova and parasites
Complete Blood Count with Differentials and Peripheral Blood Smear
- A low hemoglobin or hematocrit with microcytosis or marginal normocytosis may be observed and is indicative of iron deficiency anemia from blood loss
- Peripheral blood eosinophilia may rarely be observed in FPIES
- Elevated white blood cells with a left shift may be observed in severe acute FPIES
Iron studies
- Low ferritin with a high TIBC is suggestive of chronic blood loss by inflammatory bowel disease
- High ferritin may be suggestive of anemia of chronic inflammatory conditions
Complete Metabolic Panel
- May demonstrate hypoalbuminemia, especially in children with chronic FPIES
- Metabolic acidosis may be observed in FPIES
Other tests
- Methemoglobinemia may be observed in severe acute FPIES[4]
- Serum IgE test against the offending food protein is usually negative
- Atypical-pANCA antibodies of IgG may be observed in some patients. This is not pathognomonic of allergic colitis.
- Atopy patch test (APT), although not recommended presently for diagnosis of allergic colitis, may be useful to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism.[5]
References
- ↑ Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K; et al. (2010). "World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines". Pediatr Allergy Immunol. 21 Suppl 21: 1–125. doi:10.1111/j.1399-3038.2010.01068.x. PMID 20618740.
- ↑ Pumberger W, Pomberger G, Geissler W (2001). "Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood". Postgrad Med J. 77 (906): 252–4. PMC 1741985. PMID 11264489.
- ↑ Nowak-Węgrzyn A (2015). "Food protein-induced enterocolitis syndrome and allergic proctocolitis". Allergy Asthma Proc. 36 (3): 172–84. doi:10.2500/aap.2015.36.3811. PMC 4405595. PMID 25976434.
- ↑ Feuille E, Nowak-Węgrzyn A (2014). "Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome". Curr Opin Allergy Clin Immunol. 14 (3): 222–8. doi:10.1097/ACI.0000000000000055. PMC 4011631. PMID 24686276.
- ↑ Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T; et al. (2011). "Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation". BMC Gastroenterol. 11: 82. doi:10.1186/1471-230X-11-82. PMC 3224143. PMID 21762530.