Beginning >> Diseases >> Digestion diseases >> Allergic enteropathies

Food

Reference
Food of the child
Diseases
Drugs
Question-answer

Allergic enteropathies

Carry the intestines diseases caused by antigens of a food origin to allergic enteropathies; they are characterized by emergence as intestinal symptoms (an abdominal pain, diarrhea, etc.), and the various abenteric manifestations caused by allergic reactions of an organism in response to antigenic aggression.

Epidemiology
Epidemiological researches were not conducted.

Etiology and pathogeny
Many foodstuff possesses allergic properties. Especially often allergic reactions are caused by chocolate, coffee, nuts, oranges, wild strawberry, crabs, eggs, milk, etc. 4 types of reactions of an organism to a food-borne allergen are possible.

Reaction of the 1st type is connected with penetration of allergen through an epithelial barrier of a mucous membrane of intestines and receipt it in blood. At persons with the broken barrier function of intestines penetration of large molecules of a food origin considerably is facilitated. At reaction of the 1st type the intestinal wall is not damaged by allergen, and clinical symptoms are characterized by generally intestinal dysfunctions. The allergy to milk can be an example of reaction of the 1st type. Antigenic properties in this case the beta lactoglobulin which is contained in cow's milk possesses. At its use in food the allergic enteropathy can be shown by an abdominal pain and a profuse diarrhea. It is enough to exclude cow's milk from food or symptoms of an allergy stop replacing it at artificial feeding of children with women's milk and.

Reaction of the 2nd type develops at interaction of antigen with the antibodies concentrating in a submucosal layer of an intestinal wall. In this case enterocytes are damaged and the atrophy vorsin owing to sharp shortening of life expectancy of an intestinal epithelium develops. The allergy to gluten observed at a Gee's disease is an example of reaction of the 2nd type.

Gistochuvstvitelny HLA-B8 and HLA-D3 antigens and the antigen located on a surface of V-lymphocytes are found in patients with a Gee's disease. Together with gluten these antigens form the difficult cell-bound immune complexes connecting to receptors of cells of an intestinal wall and damaging them.

Reaction of the 3rd type is characterized by damage of vessels by the formed cell-bound immune complexes, i.e. emergence of a phenomenon of Artyus. Morphologically this reaction is shown by the hemorrhagic and destructive damages of an intestinal wall similar to those at ulcer colitis. With the advent of Artyus's phenomenon also many system manifestations at intestines diseases are connected — a knotty erythema, damages of joints and eyes.

Reaction of the 4th type is connected with inflammatory processes of immune genesis and is characterized by a granulematozny inflammation of a wall of a gut as it is observed at an illness Krone.
Thus, allergic enteropathies lead to considerable disturbances of intestinal digestion owing to decrease in products of digestive enzymes and to malabsorption, increase of secretion of water and electrolytes in a gut gleam. Allergic reactions can be followed by various morphological changes of a wall of a gut up to limfoplazmotsitarny infiltrates, ulcer and hemorrhagic and granulematozny with education, in a submucosal layer.

Classification
Classification allergic enteropathies is not developed.

Approximate formulation of the diagnosis:
1. Food allergy: intolerance of proteins of milk; a syndrome of the angry intestines with dominance of diarrhea.
2. Polyvalent food allergy (intolerance of eggs, citrus, milk); the expressed intestines dyskinesia.

Diagnosis, differential diagnosis
Crucial importance in diagnosis belongs to careful collecting "the food anamnesis", identification of the products causing an allergy. Their exception of a diet promotes involution of clinical symptoms and morphological changes in an intestines wall.

The allergic enteropathy needs to be differentiated from the food intolerantnost connected with deficit of digestive enzymes and also from absorption disturbances. Disturbances of digestion can be caused by deficit of the enzymes of a pancreas, stomach and frustration of a bile production providing digestion of feedstuffs and cavities of a gut (band digestion) and also with insufficiency of actually intestinal enzymes providing a final proteopepsis, fats and carbohydrates (membrane digestion). Despite similarity of many symptoms patients with an allergic enteropathy have no qualitative characters of the broken absorption, disturbances of an electrolytic exchange. At the same time the eosinophilia and allergic reactions in the form of skin rash, arthritises etc. are characteristic of these patients. More exact differential diagnosis is based on statement of skin tests with food-borne allergens, research in IgE blood which concentration increases at food allergy.
Differential diagnostic characters of each of four types of disturbance of assimilation in intestines are provided in the table.


Differential diagnostic characters of the allergic enteropathy and food intolerantnost connected with disturbances of intestinal digestion and absorption

Symptoms

Types of disturbances of assimilation

allergic enteropathy

insufficiency of band digestion

insufficiency of membrane digestion

insufficiency of absorption

Diarrhea

+++

+

++

+++

Polyexcrements

+++

++

+++

Steatorrhea

+++

++

+++

Decrease in body weight

+

+

+

+++

High-quality disturbances of a trophicity (change of skin, mucous membranes, nails, hair etc.)

 

 

 

+++

Disturbances of an exchange of potassium, calcium, other ions (osteoporosis, a symptom of "the muscular roller", decrease in potassium concentration, calcium in blood serum)

 

 

 

+++

Anemia, decrease in concentration of iron, protein in blood serum

 

 

 

+++

Allergic reactions (knotty erythema, skin rash, arthritises)

+++

 

 

 

Eosinophilia

+++

Symbols: (—) the symptom is not characteristic; (+) — the symptom meets seldom; (++) — the symptom meets often; (+++) — the symptom is characteristic of this type of disturbances of assimilation.

Treatment
Treatment at a food enteropathy includes purpose of a diet from which the foodstuff causing illness symptoms is excluded. Surely appoint antihistaminic drugs — antagonists of H1 receptors (tavegil on 1 tablet 2 times a day, dimebon on 10 — 20 mg 2 — 3 times a day, etc.) and antagonists of H2 receptors (Cimetidinum on 200 mg 2 times a day) within 10 — 15 days. Now use the drugs preventing degranulation of mast cells and allocation of a histamine. Treat them Zaditenum and nalkry.
These drugs are effective at food allergies. Appoint them in 30 min. prior to food, Zaditenum in a dose of 1 mg and nalkry on 200 mg 2 — 3 times a day during 3 — 4 weeks.

 
"Nutritional dystrophy   Intestines atony"
To read still
  • Medical foods at allergies
  • Measures for the prevention of contact with allergens
  • Allergy diagnostic tests
  • Epidermolysis toxic at children
  • Allergy