History

Fact Explanation
An infant Food related allergic gastroenteritis is a spectrum of hypersensitivity disorders, [1, 2] occurring commonly in infancy and they outgrow from it. [3, 4, 5]
An adult Adult onset allergic gastropathies are rare [6] but associated with possibly fatal outcomes [6]. Some present as an incidental finding while investigating for diarrhea and abdominal pain. [7]
An identifiable risk factor The common hypersensitivity cause is cows' milk protein. [4, 8, 9] Others are soy milk, peanuts, corn, carrots, rye, wheat, white of the egg, cod, and chicken. [10]
Diarrhea One of the commonest presentations [11]. This is due to Ig-E mediated hypersensitivity in children and T lymphocyte-mediated (i.e. non-IgE associated) in young adults. [12] Some can present with constipation too, rarely. [10]
Blood in stools Due to allergic procto-colitis. [2, 11, 12, 13]
Vomiting Another major symptom, probably due to the same pathophysiology of diarrhea. [11] Once the offending food item has been re-introduced, vomiting is the first symptom to appear. [11]
Weight loss There can be significant weight loss, and in the case of infants, failure to thrive is possible. [11, 14] Due to dehydration and malabsorption. [15]
Abdominal pain Another common presentation. [11, 16]
Association with other allergic phenomena The allergic gastroenteritis can be associated with other atopic conditions. i.e. atopic dermatitis, food allergy, rhinitis, bronchial asthma. [4, 10, 17, 18] But gastrointestinal disorders manifest independent of the type of allergic reactions inducing atopic manifestations. [10]
Family history of atopy The risk of atopy increases if a parent or sibling has atopic disease (20–40% and 25–35%, respectively), and is higher still if both parents are atopic (40–60%). [9]
References
  1. 2014 ICD-10-CM Diagnosis Code K52.2: Allergic and dietetic gastroenteritis and colitis. [web] [viewed 13 September 2014] Available from: http://www.icd10data.com/ICD10CM/Codes/K00-K95/K50-K52/K52-/K52.2
  2. BISCHOFF SC. Food allergy and eosinophilic gastroenteritis and colitis. Curr Opin Allergy Clin Immunol [online] 2010 Jun, 10(3):238-45 [viewed 13 September 2014] Available from: doi:10.1097/ACI.0b013e32833982c3
  3. NOVEMBRE E., VIERUCCI A.. Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Allergy [online] 2001 April, 56(s67):105-108 [viewed 13 September 2014] Available from: doi:10.1111/j.1398-9995.2001.00931.x
  4. HOST ARNE, HALKEN SUSANNE, JACOBSEN HANS P., CHRISTENSEN ANNE E., HERSKIND ANNE M., PLESNER KARIN. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol [online] 2002 December, 13(s15):23-28 [viewed 13 September 2014] Available from: doi:10.1034/j.1399-3038.13.s.15.7.x
  5. CHEHADE MIRNA, MAGID MARGRET S., MOFIDI SHIDEH, NOWAK-WEGRZYN ANNA, SAMPSON HUGH A., SICHERER SCOTT H.. Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy. Journal of Pediatric Gastroenterology and Nutrition [online] 2006 May, 42(5):516-521 [viewed 13 September 2014] Available from: doi:10.1097/01.mpg.0000221903.61157.4e
  6. SUZUKI SHINTARO, HOMMA TETSUYA, KUROKAWA MASATSUGU, MATSUKURA SATOSHI, ADACHI MITSURU, WAKABAYASHI KENJI, NOZU FUMIHIKO, TAZAKI TOSHIYUKI, KIMURA TERUAKI, MATSUURA TAKAYUKI, FUKUDA MITSURU, SHIOZAWA EISUKE, TAKIMOTO MASAFUMI. Eosinophilic Gastroenteritis due to Cow’s Milk Allergy Presenting with Acute Pancreatitis. Int Arch Allergy Immunol [online] 2012 December, 158(s1):75-82 [viewed 13 September 2014] Available from: doi:10.1159/000337782
  7. FREEMAN HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes World J Gastroenterol [online] 2008 Nov 28, 14(44):6771-6773 [viewed 13 September 2014] Available from: doi:10.3748/wjg.14.6771
  8. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 13 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  9. VANDENPLAS Y., BRUETON M., DUPONT C., HILL D., ISOLAURI E., KOLETZKO S., ORANJE A. P, STAIANO A.. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Archives of Disease in Childhood [online] 2007 October, 92(10):902-908 [viewed 13 September 2014] Available from: doi:10.1136/adc.2006.110999
  10. ROKAITE R, LABANAUSKAS L. Gastrointestinal disorders in children with atopic dermatitis. Medicina (Kaunas) [online] 2005, 41(10):837-45 [viewed 13 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16272830
  11. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  12. ALFADDA AA, STORR MA, SHAFFER EA. Eosinophilic colitis: epidemiology, clinical features, and current management Therap Adv Gastroenterol [online] 2011 Sep, 4(5):301-309 [viewed 14 September 2014] Available from: doi:10.1177/1756283X10392443
  13. ROSEKRANS PC, MEIJER CJ, VAN DER WAL AM, LINDEMAN J. Allergic proctitis, a clinical and immunopathological entity. Gut [online] 1980 Dec, 21(12):1017-23 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6780413
  14. SICHERER S.H. Manifestations of Food Allergy: Evaluation and Management. Am Fam Physician. [online] 1999 Jan 15;59(2):415-424. [viewed 14 September 2014] Available from: http://www.aafp.org/afp/1999/0115/p415.html
  15. FREEMAN HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes World J Gastroenterol [online] 2008 Nov 28, 14(44):6771-6773 [viewed 14 September 2014] Available from: doi:10.3748/wjg.14.6771
  16. AKHAVEIN M A., PATEL N. R., MUNIYAPPA P. K., GLOVER S. C.. Allergic Mastocytic Gastroenteritis and Colitis: An Unexplained Etiology in Chronic Abdominal Pain and Gastrointestinal Dysmotility. Gastroenterology Research and Practice [online] 2012 December, 2012:1-6 [viewed 14 September 2014] Available from: doi:10.1155/2012/950582
  17. PARK HS, KIM HS, JANG HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci [online] 1995 Jun, 10(3):216-9 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8527050
  18. NOVEMBRE E., VIERUCCI A.. Milk allergy/intolerance and atopic dermatitis in infancy and childhood. Allergy [online] 2001 April, 56(s67):105-108 [viewed 14 September 2014] Available from: doi:10.1111/j.1398-9995.2001.00931.x

Examination

Fact Explanation
Loss of weight Due to dehydration and mal-absorption. Weight should be plotted in a standard growth chart to identify failure to thrive in infants. [1, 2, 3, 4, 5, 6]
Features of dehydration i.e. decreased peripheral perfusion (indicated by capillary refilling time) , deep breathing, decreased skin turgor, sunken eyes, dry mouth, sunken fontanelle and absence of tears. Due to recurrent vomiting and diarrhea. [1, 7, 8]
Blood pressure Continuous vomiting and diarrhea can be associated with hypovolemic shock. [1, 9, 10]
Pallor Due to blood loss with stools. [11, 12]
Abdominal examination Diffuse tenderness has been reported. In severe cases where malnourishment is prominent, fluid in peritoneal cavity can also be noticed. [13, 14, 15, 16]
References
  1. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  2. SICHERER S.H. Manifestations of Food Allergy: Evaluation and Management. Am Fam Physician. [online] 1999 Jan 15;59(2):415-424. [viewed 14 September 2014] Available from: http://www.aafp.org/afp/1999/0115/p415.html
  3. FREEMAN HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes World J Gastroenterol [online] 2008 Nov 28, 14(44):6771-6773 [viewed 14 September 2014] Available from: doi:10.3748/wjg.14.6771
  4. BRILL H. Approach to milk protein allergy in infants Can Fam Physician [online] 2008 Sep, 54(9):1258-1264 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553152
  5. COLE S.Z. and LANHAM J.S. Failure to Thrive: An Update. Am Fam Physician. [online] 2011 Apr 1;83(7):829-834. [viewed 14 September 2014] Available from: http://www.aafp.org/afp/2011/0401/p829.html
  6. KEMP A.S. et al. Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion. Med J Aust [online] 2008; 188 (2): 109-112. [viewed 14 September 2014] Available from: https://www.mja.com.au/journal/2008/188/2/guidelines-use-infant-formulas-treat-cows-milk-protein-allergy-australian
  7. MACKENZIE A, BARNES G, SHANN F. Clinical signs of dehydration in children. Lancet [online] 1989 Sep 9, 2(8663):605-7 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2570294
  8. BAILEY BENOIT, GRAVEL JOCELYN, GOLDMAN RAN D., FRIEDMAN JEREMY N., PARKIN PATRICIA C.. External Validation of the Clinical Dehydration Scale for Children With Acute Gastroenteritis. [online] 2010 May, 17(6):583-588 [viewed 14 September 2014] Available from: doi:10.1111/j.1553-2712.2010.00767.x
  9. SINHA ADITI. A Beef Case: A Short Report Of Food Protein Induced Enterocolitis Syndrome. Pediatric Oncall [online] 2014 January [viewed 14 September 2014] Available from: doi:10.7199/ped.oncall.2014.12
  10. CHEHADE MIRNA, MAGID MARGRET S., MOFIDI SHIDEH, NOWAK-WEGRZYN ANNA, SAMPSON HUGH A., SICHERER SCOTT H.. Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy. Journal of Pediatric Gastroenterology and Nutrition [online] 2006 May, 42(5):516-521 [viewed 14 September 2014] Available from: doi:10.1097/01.mpg.0000221903.61157.4e
  11. EKUNNO N, MUNSAYAC K, PELLETIER A, WILKINS T. Eosinophilic gastroenteritis presenting with severe anemia and near syncope. J Am Board Fam Med [online] 2012 Nov-Dec, 25(6):913-8 [viewed 14 September 2014] Available from: doi:10.3122/jabfm.2012.06.110269
  12. CHEHADE MIRNA, MAGID MARGRET S., MOFIDI SHIDEH, NOWAK-WEGRZYN ANNA, SAMPSON HUGH A., SICHERER SCOTT H.. Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy. Journal of Pediatric Gastroenterology and Nutrition [online] 2006 May, 42(5):516-521 [viewed 14 September 2014] Available from: doi:10.1097/01.mpg.0000221903.61157.4e
  13. LIM DENNIS N. F., WILKINS ANNELISE, HORTON LAURA ELIZABETH, AHMAD ISHFAQ, LO POLITO CATHERINE, PHILLIPS CHRIS. Eosinophilic Gastrointestinal Disorder in Coeliac Disease: A Case Report and Review. Case Reports in Gastrointestinal Medicine [online] 2012 December, 2012:1-4 [viewed 14 September 2014] Available from: doi:10.1155/2012/124275
  14. TAKEYAMA J, ABUKAWA D, MIURA K. Eosinophilic gastroenteritis with cytomegalovirus infection in an immunocompetent child. World J Gastroenterol [online] 2007; 13(34): 4653-4654 [viewed 14 September 2014] Available from: http://www.wjgnet.com/1007-9327/13/4653.asp
  15. AKHAVEIN M A., PATEL N. R., MUNIYAPPA P. K., GLOVER S. C.. Allergic Mastocytic Gastroenteritis and Colitis: An Unexplained Etiology in Chronic Abdominal Pain and Gastrointestinal Dysmotility. Gastroenterology Research and Practice [online] 2012 December, 2012:1-6 [viewed 14 September 2014] Available from: doi:10.1155/2012/950582
  16. QUACK IVO, SELLIN LORENZ, BUCHNER NIKOLAUS J, THEEGARTEN DIRK, RUMP LARS C, HENNING BERNHARD F. . BMC Gastroenterol [online] 2005 December [viewed 14 September 2014] Available from: doi:10.1186/1471-230X-5-24

Differential Diagnoses

Fact Explanation
Inflammatory Bowel Disease (IBD) Symptoms of atopic gastrointestinal diseases frequently mimic those of other chronic inflammatory bowel diseases, although the diseases are distinct in their histopathology, gene expression signature, response to therapy, and association with allergies. [1] In some cases, endoscopy also can look similar. [2, 3] Diagnosis is by histological studies. [3]
Parasitic infections i.e. pinworms, roundworms, or whipworms. There can be significant weight loss and symptoms of indigestion, and there can be significant eosinophilic infiltration. [3, 4, 5]
Drug induced gastroenteritis The common drugs that induce eosinophilic colitis are clozapine, carbamazepine, rifampicin, non-steroidal anti-inflammatory agents, tacrolimus, and gold salts. [3, 6, 7, 8, 9, 10]
References
  1. BISCHOFF STEPHAN C. Food allergy and eosinophilic gastroenteritis and colitis. Current Opinion in Allergy and Clinical Immunology [online] 2010 June, 10(3):238-245 [viewed 14 September 2014] Available from: doi:10.1097/ACI.0b013e32833982c3
  2. PARK HS, KIM HS, JANG HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci [online] 1995 Jun, 10(3):216-219 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3054114
  3. OKPARA N, ASWAD B, BAFFY G. Eosinophilic colitis World J Gastroenterol [online] 2009 Jun 28, 15(24):2975-2979 [viewed 14 September 2014] Available from: doi:10.3748/wjg.15.2975
  4. MACEDO T, MACCARTY RL. Eosinophilic ileocolitis secondary to Enterobius vermicularis: case report. Abdom Imaging [online] 2000 Sep-Oct, 25(5):530-2 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10931992, DOI 10.1107/s002610000042
  5. CHANDRASEKHARA VINAY, ARSLANLAR SAMI, SREENARASIMHAIAH JAYAPRAKASH. Whipworm infection resulting in eosinophilic colitis with occult intestinal bleeding. Gastrointestinal Endoscopy [online] 2007 April, 65(4):709-710 [viewed 14 September 2014] Available from: doi:10.1016/j.gie.2006.07.005
  6. KARMACHARYA R.. Clozapine-Induced Eosinophilic Colitis. American Journal of Psychiatry [online] 2005 July, 162(7):1386-1387 [viewed 14 September 2014] Available from: doi:10.1176/appi.ajp.162.7.1386-a
  7. ANTTILA VELI-JUKKA, VALTONEN MATTI. Carbamazepine-Induced Eosinophilic Colitis. Epilepsia [online] 1992 January, 33(1):119-121 [viewed 14 September 2014] Available from: doi:10.1111/j.1528-1157.1992.tb02293.x
  8. LANGE P., OUN H., FULLER S., TURNEY J.H.. Eosinophilic colitis due to rifampicin. The Lancet [online] 1994 November, 344(8932):1296-1297 [viewed 14 September 2014] Available from: doi:10.1016/S0140-6736(94)90782-X
  9. BRIDGES ALAN J., MARSHALL JOHN B., DIAZ-ARIAS ALBERTO A.. Acute eosinophilic colitis and hypersensitivity reaction associated with naproxen therapy. The American Journal of Medicine [online] 1990 October, 89(4):526-527 [viewed 14 September 2014] Available from: doi:10.1016/0002-9343(90)90386-R
  10. SAEED SHEHZAD A., INTEGLIA MARK J., PLESKOW RANDI G., CALENDA KATHLEEN A., ROHRER RICHARD J., DAYAL YOGESHWAR, GRAND RICHARD J.. Tacrolimus-associated eosinophilic gastroenterocolitis in pediatric liver transplant recipients: Role of potential food allergies in pathogenesis. [online] 2006 September, 10(6):730-735 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3046.2006.00538.x

Investigations - for Diagnosis

Fact Explanation
Complete blood count Peripheral blood eosinophilia is expected due to the hypersensitivity reaction. [1, 2] Where there has been significant blood loss with stools, anemia also can be expected. [3, 4]
Skin prick test (SPT) To diagnose the presence of distinguishable allergens. Appropriate and specific allergen extracts should be used, with using normal saline pricks as negative controls. Interpretation of the tests should be done after 15 - 20 minutes of application. Positive results are defined as a wheal ≥3 mm diameter. [5, 6, 7, 8, 9]
Endoscopy Diffuse hyperemia and edema are features of inflammatory reaction in the mucosa. Can take biopsies at the same time. [1, 2, 10, 11, 12, 13]
Histology Infiltration of GI mucosa with eosinophils. [1, 2, 10, 11, 12, 13]
Serum electrolytes To exclude hypernatremia or hypokalemia, which should be addressed in management if present, and rule out acute renal failure. [14, 15]
Blood urea and serum creatinine Blood urea and serum creatinine are markers of acute renal failure. [16, 17]
References
  1. OKPARA N, ASWAD B, BAFFY G. Eosinophilic colitis World J Gastroenterol [online] 2009 Jun 28, 15(24):2975-2979 [viewed 14 September 2014] Available from: doi:10.3748/wjg.15.2975
  2. YAN BM, SHAFFER EA. Primary eosinophilic disorders of the gastrointestinal tract. Gut [online] 2009 May, 58(5):721-32 [viewed 14 September 2014] Available from: doi:10.1136/gut.2008.165894
  3. EKUNNO N, MUNSAYAC K, PELLETIER A, WILKINS T. Eosinophilic gastroenteritis presenting with severe anemia and near syncope. J Am Board Fam Med [online] 2012 Nov-Dec, 25(6):913-8 [viewed 14 September 2014] Available from: doi:10.3122/jabfm.2012.06.110269
  4. CHEHADE MIRNA, MAGID MARGRET S., MOFIDI SHIDEH, NOWAK-WEGRZYN ANNA, SAMPSON HUGH A., SICHERER SCOTT H.. Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy. Journal of Pediatric Gastroenterology and Nutrition [online] 2006 May, 42(5):516-521 [viewed 14 September 2014] Available from: doi:10.1097/01.mpg.0000221903.61157.4e
  5. RODRíGUEZ JIMéNEZ B, DOMíNGUEZ ORTEGA J, GONZáLEZ GARCíA JM, KINDELAN RECARTE C. Eosinophilic gastroenteritis due to allergy to cow's milk. J Investig Allergol Clin Immunol [online] 2011, 21(2):150-2 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21462806
  6. PARK HS, KIM HS, JANG HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci [online] 1995 Jun, 10(3):216-9 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8527050
  7. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  8. HEINZERLING L, MARI A, BERGMANN KC, BRESCIANI M, BURBACH G, DARSOW U, DURHAM S, FOKKENS W, GJOMARKAJ M, HAAHTELA T, BOM AT, WöHRL S, MAIBACH H, LOCKEY R. The skin prick test - European standards. Clin Transl Allergy [online] 2013 Feb 1, 3(1):3 [viewed 14 September 2014] Available from: doi:10.1186/2045-7022-3-3
  9. HILL DAVID J., HEINE RALF G., HOSKING CLIFFORD S.. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol [online] 2004 October, 15(5):435-441 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2004.00188.x
  10. PARK HS, KIM HS, JANG HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci [online] 1995 Jun, 10(3):216-219 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3054114
  11. FREEMAN HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes World J Gastroenterol [online] 2008 Nov 28, 14(44):6771-6773 [viewed 14 September 2014] Available from: doi:10.3748/wjg.14.6771
  12. ROSEKRANS PC, MEIJER CJ, VAN DER WAL AM, LINDEMAN J. Allergic proctitis, a clinical and immunopathological entity. Gut [online] 1980 Dec, 21(12):1017-23 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6780413
  13. ALFADDA AA, STORR MA, SHAFFER EA. Eosinophilic colitis: epidemiology, clinical features, and current management Therap Adv Gastroenterol [online] 2011 Sep, 4(5):301-309 [viewed 14 September 2014] Available from: doi:10.1177/1756283X10392443
  14. GENNARI F. J., WEISE W. J.. Acid-Base Disturbances in Gastrointestinal Disease. Clinical Journal of the American Society of Nephrology [online] 2008 October, 3(6):1861-1868 [viewed 14 September 2014] Available from: doi:10.2215/​CJN.02450508
  15. SWINGLER G. Seasonal plasma electrolyte fluctuations in childhood diarrhoea. [online] 2002 November, 87(5):426-427 [viewed 14 September 2014] Available from: doi:10.1136/adc.87.5.426
  16. YILMAZ K, KARABöCüOGLU M, ÇITAK A, UZEL N. Evaluation of laboratory tests in dehydrated children withacute gastroenteritis. [online] 2002 June, 38(3):226-228 [viewed 15 September 2014] Available from: doi:10.1046/j.1440-1754.2002.00792.x
  17. PRIGENT ALAIN. Monitoring Renal Function and Limitations of Renal Function Tests. Seminars in Nuclear Medicine [online] 2008 January, 38(1):32-46 [viewed 15 September 2014] Available from: doi:10.1053/j.semnuclmed.2007.09.003

Investigations - Fitness for Management

Fact Explanation
Complete blood count To exclude anemia, infection and thrombocytopenia before the surgical management option. [1, 2]
Renal functions i.e. serun electrolytes, blood urea, serum creatinine. To see the evidence of renal function after correction of the dehydration. [3, 4, 5, 6, 7]
Chest X-ray To exclude respiratory illness prior to surgery. [8]
12-lead elecrocardiogram To exclude cardiac diseases prior to surgery. [9, 10]
Fasting blood sugar To exclude asymptomatic hyperglycemia before surgery. [11]
References
  1. APIRO MARTIN F.. Diagnostic Decision: The Complete Blood Count and Leukocyte Differential Count: An Approach to Their Rational Application. Ann Intern Med [online] 1987 January [viewed 08 June 2014] Available from: doi:10.7326/0003-4819-106-1-65
  2. BLUMENREICH MS. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition [web]; Chapter 153, The White Blood Cell and Differential Count. [viewed 08 June 2014] Available at http://www.ncbi.nlm.nih.gov/books/NBK261/
  3. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  4. MACKENZIE A, BARNES G, SHANN F. Clinical signs of dehydration in children. Lancet [online] 1989 Sep 9, 2(8663):605-7 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2570294
  5. BAILEY BENOIT, GRAVEL JOCELYN, GOLDMAN RAN D., FRIEDMAN JEREMY N., PARKIN PATRICIA C.. External Validation of the Clinical Dehydration Scale for Children With Acute Gastroenteritis. [online] 2010 May, 17(6):583-588 [viewed 14 September 2014] Available from: doi:10.1111/j.1553-2712.2010.00767.x
  6. GENNARI F. J., WEISE W. J.. Acid-Base Disturbances in Gastrointestinal Disease. Clinical Journal of the American Society of Nephrology [online] 2008 October, 3(6):1861-1868 [viewed 14 September 2014] Available from: doi:10.2215/​CJN.02450508
  7. SWINGLER G. Seasonal plasma electrolyte fluctuations in childhood diarrhoea. [online] 2002 November, 87(5):426-427 [viewed 14 September 2014] Available from: doi:10.1136/adc.87.5.426
  8. ARCHER CHANTAI, LEVY ADRIAN R., MCGREGOR MAURICE. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth [online] 1993 November, 40(11):1022-1027 [viewed 14 September 2014] Available from: doi:10.1007/BF03009471
  9. VAN KLEI WA, BRYSON GL, YANG H, KALKMAN CJ, WELLS GA, BEATTIE WS. The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery. Ann Surg [online] 2007 Aug, 246(2):165-70 [viewed 14 September 2014] Available from: doi:10.1097/01.sla.0000261737.62514.63
  10. NASH GF, CUNNICK GH, ALLEN S, COOK C, TURNER LF. Pre-operative electrocardiograph examination. Ann R Coll Surg Engl [online] 2001 Nov, 83(6):381-2 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11777129
  11. RAJU TA, TORJMAN MC, GOLDBERG ME. Perioperative Blood Glucose Monitoring in the General Surgical Population J Diabetes Sci Technol [online] , 3(6):1282-1287 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787027

Management - General Measures

Fact Explanation
Avoid offending food item Avoid the offending food item till the patient is clinically well and hypersensitivity to it is excluded by skin prick test. [1] In cases of cows' milk hypersensitivity in infants, Elimination of cow's milk protein from the infant's or mother's diet and challenges are the gold standard for diagnosis. [2]
Hydration To prevent hypovolemia. [3, 4, 5]
Education of the parents and helathcare workers Education about the nature of the illness, predisposing factors and the importance about the dietary management. i.e. avoidance of the offending food itme, using substitutes. [6, 7, 8]
References
  1. PARK HS, KIM HS, JANG HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci [online] 1995 Jun, 10(3):216-219 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3054114
  2. VANDENPLAS Y, KOLETZKO S, ISOLAURI E, HILL D, ORANJE AP, BRUETON M, STAIANO A, DUPONT C. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child [online] 2007 Oct, 92(10):902-8 [viewed 14 September 2014] Available from: doi:10.1136/adc.2006.110999
  3. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  4. SINHA ADITI. A Beef Case: A Short Report Of Food Protein Induced Enterocolitis Syndrome. Pediatric Oncall [online] 2014 January [viewed 14 September 2014] Available from: doi:10.7199/ped.oncall.2014.12
  5. CHEHADE MIRNA, MAGID MARGRET S., MOFIDI SHIDEH, NOWAK-WEGRZYN ANNA, SAMPSON HUGH A., SICHERER SCOTT H.. Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy. Journal of Pediatric Gastroenterology and Nutrition [online] 2006 May, 42(5):516-521 [viewed 14 September 2014] Available from: doi:10.1097/01.mpg.0000221903.61157.4e
  6. VANDENPLAS Y., BRUETON M., DUPONT C., HILL D., ISOLAURI E., KOLETZKO S., ORANJE A. P, STAIANO A.. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Archives of Disease in Childhood [online] 2007 October, 92(10):902-908 [viewed 14 September 2014] Available from: doi:10.1136/adc.2006.110999
  7. MIKKELSEN ANDREA, LISSNER LAUREN, BORRES MAGNUS P.. Milk allergy school: Nutritional therapy in group for parents of children with cow's milk allergy/intolerance in Primary Health Care. Pediatr Allergy Immunol [online] 2005 February, 16(1):86-90 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2005.00228.x
  8. KNEEPKENS CM, MEIJER Y. Clinical practice. Diagnosis and treatment of cow's milk allergy Eur J Pediatr [online] 2009 Aug, 168(8):891-896 [viewed 14 September 2014] Available from: doi:10.1007/s00431-009-0955-7

Management - Specific Treatments

Fact Explanation
Amino acid formula (AAF) For infants who have failure to thrive, suffer from macronutrient deficiencies or have pain. AAF is hypoallergenic, minimises the risk of failure on an eHF and further weight loss. [1, 2, 3, 4]
Corticosteroids The drug of choice for anti-inflammatory effect on the GI mucosa. Combined together with avoidance of offending food item, can cause complete recovery. [5, 6, 7, 8, 9]
Other drugs These are not widely used, but some benefits have been proven than using corticosteroids because of the side effects of them. i.e. proton pump inhibitors, mast cell stabilizers, ketotifen, leukotriene antagonists and octreotide. [6, 10, 11, 12]
Surgical resection Resection of involved intestinal segments can be done in refractory cases. [6, 13]
References
  1. VANDENPLAS Y, KOLETZKO S, ISOLAURI E, HILL D, ORANJE AP, BRUETON M, STAIANO A, DUPONT C. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child [online] 2007 Oct, 92(10):902-8 [viewed 14 September 2014] Available from: doi:10.1136/adc.2006.110999
  2. MALONEY JENNIFER, NOWAK-WEGRZYN ANNA. Educational clinical case series for pediatric allergy and immunology: Allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol [online] 2007 June, 18(4):360-367 [viewed 14 September 2014] Available from: doi:10.1111/j.1399-3038.2007.00561.x
  3. SICHERER SCOTT H., NOONE SALLY A., KOERNER CELIDE BARNES, CHRISTIE LYNN, BURKS A.WESLEY, SAMPSON HUGH A.. Hypoallergenicity and efficacy of an amino acid–based formula in children with cow’s milk and multiple food hypersensitivities. The Journal of Pediatrics [online] 2001 May, 138(5):688-693 [viewed 14 September 2014] Available from: doi:10.1067/mpd.2001.113007
  4. CHEHADE MIRNA, MAGID MARGRET S., MOFIDI SHIDEH, NOWAK-WEGRZYN ANNA, SAMPSON HUGH A., SICHERER SCOTT H.. Allergic Eosinophilic Gastroenteritis With Protein-losing Enteropathy. Journal of Pediatric Gastroenterology and Nutrition [online] 2006 May, 42(5):516-521 [viewed 14 September 2014] Available from: doi:10.1097/01.mpg.0000221903.61157.4e
  5. PARK HS, KIM HS, JANG HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci [online] 1995 Jun, 10(3):216-219 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3054114
  6. FREEMAN HJ. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes World J Gastroenterol [online] 2008 Nov 28, 14(44):6771-6773 [viewed 14 September 2014] Available from: doi:10.3748/wjg.14.6771
  7. KHAN S, ORENSTEIN SR. Eosinophilic gastroenteritis. Gastroenterol Clin North Am [online] 2008 Jun, 37(2):333-48, v [viewed 14 September 2014] Available from: doi:10.1016/j.gtc.2008.02.003
  8. TALLEY NJ, SHORTER RG, PHILLIPS SF, ZINSMEISTER AR. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut [online] 1990 Jan, 31(1):54-8 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2318432
  9. STRAUMANN A. Idiopathic eosinophilic gastrointestinal diseases in adults. Best Pract Res Clin Gastroenterol [online] 2008, 22(3):481-96 [viewed 14 September 2014] Available from: doi:10.1016/j.bpg.2007.09.001
  10. MELAMED ISAAC, FEANNY STEPHEN J., SHERMAN PHILIP M., ROIFMAN CHAIM M.. Benefit of ketotifen in patients with eosinophilic gastroenteritis. The American Journal of Medicine [online] 1991 March, 90(3):310-314 [viewed 14 September 2014] Available from: doi:10.1016/0002-9343(91)80010-J
  11. QUACK I, SELLIN L, BUCHNER NJ, THEEGARTEN D, RUMP LC, HENNING BF. Eosinophilic gastroenteritis in a young girl - long term remission under Montelukast BMC Gastroenterol [online] :24 [viewed 14 September 2014] Available from: doi:10.1186/1471-230X-5-24
  12. MOOTS RJ, PROUSE P, GUMPEL JM. Near fatal eosinophilic gastroenteritis responding to oral sodium chromoglycate. Gut [online] 1988 Sep, 29(9):1282-1285 [viewed 14 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1434366
  13. CHA JM, LEE JI, JOO KR, SHIN HP. Eosinophilic Gastroenteritis with Eosinophilic Dermatitis Yonsei Med J [online] 2010 Jan 1, 51(1):145-147 [viewed 14 September 2014] Available from: doi:10.3349/ymj.2010.51.1.145