Allergic colitis physical examination: Difference between revisions
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{{CMG}}; {{AE}}{{QS}} | {{CMG}}; {{AE}}{{QS}} | ||
==Overview== | ==Overview== | ||
Patients with allergic colitis may appear well in the case of FPIAP or may appear lethargic when they have FPIES. Physical examination of patients with FPIES is usually remarkable for signs of [[dehydration]], [[pallor]], and poor weight. | Patients with allergic colitis may appear well in the case of [[Food protein-induced allergic proctocolitis (FPIAP)|food protein-induced allergic proctocolitis]] (FPIAP) or may appear [[lethargic]] when they have [[Food protein-induced enterocolitis syndrome (FPIES)|food protein-induced enterocolitis syndrome]] (FPIES). Physical examination of patients with FPIES is usually remarkable for signs of [[dehydration]], [[pallor]], and poor weight. | ||
==Physical Examination== | ==Physical Examination== | ||
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! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Type of Allergic colitis}} | ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Type of Allergic colitis}} | ||
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Physical Examination}} | ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Physical Examination}} | ||
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! style="padding: 5px 5px; background: #DCDCDC; | ! rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" | '''[[Food protein-induced allergic proctocolitis]]'''<ref name="pmid24416045">{{cite journal| author=Hwang JB, Hong J| title=Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates? | journal=Korean J Pediatr | year= 2013 | volume= 56 | issue= 12 | pages= 514-8 | pmid=24416045 | doi=10.3345/kjp.2013.56.12.514 | pmc=3885785 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24416045 }} </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="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><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> | ||
| style="padding: 5px 5px; background: #F5F5F5; | | rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Child is usually well-appearing | *Child is usually well-appearing | ||
*The weight and height of the child is appropriate for age | *The weight and height of the child is appropriate for age | ||
*Mild pallor may be noticed | *Mild [[pallor]] may be noticed | ||
*Child may be restless when having abdominal pain | *Child may be restless when having [[abdominal pain]] | ||
*Stool contain streak of blood with or without mucus | *Stool contain streak of blood with or without mucus | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC; | ! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | '''[[Food protein-induced enterocolitis syndrome]]'''<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> | ||
| style="padding: 5px 5px; background: #F5F5F5; | | rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" |'''Acute''' | ||
*The child is dehydrated within a few hours after exposure to the offending protein | *The child is [[dehydrated]] within a few hours after exposure to the offending protein | ||
*The child is lethargic when severe | *The child is [[lethargic]] when severe | ||
*May be in shock | *May be in [[shock]] | ||
*Pallor is observed, especially with frank bloody diarrhea | *Pallor is observed, especially with frank [[bloody diarrhea]] | ||
*The child may appear dusky | *The child may appear dusky | ||
*Abdominal distention may be seen | *[[Abdominal distention]] may be seen | ||
*May develop [[edema]] | *May develop [[edema]] | ||
|- | |- | ||
|style="padding: 5px 5px; background: #F5F5F5; | | rowspan="1" style="padding: 5px 5px; background: #F5F5F5;" |'''Chronic''' | ||
Symptoms occur with a background chronic exposure | Symptoms occur with a background chronic exposure | ||
*The child's weight and height are low for the age | *The child's weight and height are low for the age | ||
*May develop edema | *May develop edema | ||
*May have [[abdominal distension]] | *May have [[abdominal distension]] | ||
*Signs of dehydration will also be observed following acute exposure | *Signs of [[dehydration]] will also be observed following acute exposure | ||
|} | |} | ||
Latest revision as of 16:24, 1 February 2018
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Allergic colitis physical examination On the Web |
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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
Patients with allergic colitis may appear well in the case of food protein-induced allergic proctocolitis (FPIAP) or may appear lethargic when they have food protein-induced enterocolitis syndrome (FPIES). Physical examination of patients with FPIES is usually remarkable for signs of dehydration, pallor, and poor weight.
Physical Examination
| Type of Allergic colitis | Physical Examination |
|---|---|
| Food protein-induced allergic proctocolitis[1][2][3][4] |
|
| Food protein-induced enterocolitis syndrome[4] | Acute
|
| Chronic
Symptoms occur with a background chronic exposure
|
Diagnosis
- There is no definitive diagnostic criteria for allergic colitis. Diagnosis of allergic colitis is based on detailed clinical assessment (history and physical findings) and additional endoscopic findings for those with atypical presentation. The National Institute of Allergy and Infectious Diseases (NIAID) expert panel recommends a detailed medical history and physical examination to rule out any other possible cause for the symptoms, the absence of symptoms while avoiding the causative food, and recurrence of symptoms following an oral food challenge test to diagnose allergic colitis.[1][4][5][6]
- Oral food allergy challenge test is considered the most important step in the diagnosis of allergic colitis. It could be single-blind, double-blind placebo-controlled challenge or open. The double-blind controlled challenge is more reliable, but in practice open challenge is most often performed.
- Recently, an international expert panel is working on evidence-based guidelines for diagnosis and management of allergic colitis to improve the care provided for patients.[7]
References
- ↑ 1.0 1.1 Hwang JB, Hong J (2013). "Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates?". Korean J Pediatr. 56 (12): 514–8. doi:10.3345/kjp.2013.56.12.514. PMC 3885785. PMID 24416045.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 4.2 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.
- ↑ Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA; et al. (2010). "Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report". J Allergy Clin Immunol. 126 (6): 1105–18. doi:10.1016/j.jaci.2010.10.008. PMC 4241958. PMID 21134568.
- ↑ Lake AM (2000). "Food-induced eosinophilic proctocolitis". J Pediatr Gastroenterol Nutr. 30 Suppl: S58–60. PMID 10634300.
- ↑ 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.