Abstract
Background: Short bowel syndrome is the result of an extensive surgical resection that leaves the length of the small intestine at a critical value for the proper nutritional absorption. An increased risk of food allergy has been described in patients who suffer from this condition.
Objective: To describe the prevalence of allergic diseases in a group of patients with short bowel syndrome.
Methods: A descriptive, cross-sectional, and ambispective study was carried out; it included patients with short bowel syndrome who had attended the nephrology service of the National Institute of Pediatrics in a period of 18 months. Information about medical records, surgery history, diet history, and food tolerance was collected with prior authorization of parents or legal guardians. Likewise, there was questioning about history of atopy, and validated questionnaires for allergic diseases were applied in Spanish. The following tests were carried out: skin tests with allergen extracts, determination of four foods specific immunoglobulin E, patch test, and open oral food challenge. The protocol was authorized by the research ethics committee.
Results: Fifteen patients with a median age of 44 months (range of 8-128 months) and with a male/female ratio of 2:1 were included. The most common causes of SBS were necrotizing enterocolitis and intestinal atresia. 27% of the patients had a family history of atopy and 40 % of the patients had a personal history that suggested an allergy to cow’s milk in infancy. Allergic diseases were found in 40 %.
Conclusions: Allergic diseases seem to have high prevalence in patients with SBS. More studies in large populations are required in order to confirm this discovery.
References
Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology. 2006;130(2 Suppl 1):S16-S28. DOI: 10.1053/j.gastro.2005.12.002
O’Keefe SJ, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J, et al. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol. 2006;4(1):6-10. DOI: 10.1016/j.cgh.2005.10.002.
Amin SC, Pappas C, Iyengar H, Maheshwari A. Short bowel syndrome in the NICU. Clin Perinatol. 2013;40(1):53-68. DOI: 10.1016/j.clp.2012.12.003
Gutiérrez IM, Kang KH, Jaksic T. Neonatal short bowel syndrome. Semin Fetal Neonatal Med. 2011;16(3):157-163. DOI: 10.1016/j.siny.2011.02.001
Wales PW, Christison-Lagay ER. Short bowel syndrome: epidemiology and etiology. Semin Pediatr Surg. 2010;19(1):3-9. DOI: 10.1053/j.sempedsurg.2009.11.001.
Gosselin KB, Duggan C. Enteral nutrition in the management of pediatric intestinal failure. J Pediatr. 2014;165(6):1085-1090. DOI: 10.1016/j.jpeds.2014.08.012
Cole CR, Frem JC, Schmotzer B, Gewirtz A, Meddings JB, Gold BD, et al. The rate of bloodstream infection is high in infants with short bowel syndrome: relationship with small bowel bacterial overgrowth, enteral feeding, and inflammatory and immune responses. J Pediatr. 2010;156(6):941-947. DOI: 10.1016/j.jpeds.2009.12.008
Groschwitz KR, Hogan SP. Intestinal barrier function: molecular regulation and disease pathogenesis. J Aller Clin Immunol. 2009;124(1):3-20. DOI: 10.1016/j.jaci.2009.05.038
Mazon A, Solera E, Alentado N, Oliver F, Pamies R, Caballero L, et al. Frequent IgE sensitization to latex, cow’s milk, and egg in children with short bowel syndrome. Pediatr Allergy Immunol. 2008;19(2):180-183. DOI: 10.1111/j.1399-3038.2007.00591.x
Diamanti A, Fiocchi AG, Capriati T, Panetta F, Pucci N, Bellucci F, et al. Cow’s milk allergy and neonatal short bowel syndrome: comorbidity or true association? Eur J Clin Nutr. 2015;69(1):102-106. DOI: 10.1038/ejcn.2014.156
Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483-491. DOI: 10.1183/09031936.95.08030483.
Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(Suppl 3):S1-S148. DOI: 10.1016/s1081-1206(10)60305-5
Amarasekera M. Immunoglobulin E in health and disease. Asia Pac Allergy. 2011;1(1):12-15. DOI: 10.5415/apallergy.2011.1.1.12
Turjanmaa K, Darsow U, Niggemann B, Rancé F, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy. 2006;61(12):1377-1384. DOI: 10.1111/j.1398-9995.2006.01136.x
Soares-Weiser K, Takwoingi Y, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. The diagnosis of food allergy: a systematic review and meta-analysis. Allergy. 2014;69(1):76-86. DOI: 10.1111/all.12333.
Wales PW, de Silva N, Kim J, et al. Neonatal short bowel syndrome: population-based estimates of incidence and mortality rates. J Pediatr Surg. 2004;39(5):690-695. DOI: 10.1016/j.jpedsurg.2004.01.036
Andorsky DJ, Lund DP, Lillehei CW, Jaksic T, Richardson DS, Collier SB, et al. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr. 2001;139(1):27-33. DOI: 10.1067/mpd.2001.114481.
Duro D, Kalish LA, Johnston P, Jaksic T, McMarthy M, Martin C, et al. Risk factors for intestinal failure in infants with necrotizing enterocolitis: a Glaser Pediatric Research Network study. J Pediatr. 2010;157(2):203-208. DOI: 10.1016/j.jpeds.2010.02.023
Goulet O, Olieman J, Ksiazyk J, Spolidoro J, Tibboe D, Köhler H, et al. Neonatal short bowel syndrome as a model of intestinal failure: physiological background for enteral feeding. Clin Nutr. 2013;32(2):162-171. DOI: 10.1016/j.clnu.2012.09.007.
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. World Allergy Organ J. 2010;3(4):57-161. DOI: 10.1111/j.1399-3038.2010.01068.x
Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41-58. DOI: 10.1016/j.jaci.2017.11.003.
Lin YM, Li F, Shi XZ. Mechanical stress is a pro-inflammatory stimulus in the gut: in vitro, in vivo and ex vivo evidence. PLoS One. 2014;9(9):e106242. DOI: 10.1371/journal.pone.0106242
Vanderhoof JA, Young RJ. Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children. J Pediatr Gastroenterol Nutr. 2004;38:107-112. DOI: 10.1097/00005176-200401000-00024
Wisniewski J, Lieberman J, Nowak-Wegrzyn A, et al. De novo food sensitization and eosinophilic gastrointestinal disease in children post-liver transplantation. Clin Transplant. 2012;26(4):365-371. DOI: 10.1111/j.1399-0012.2012.01670.x
Weale AR, Edwards AG, Bailey M, Lear P. Intestinal adaptation after massive intestinal resection. Postgrad Med J. 2005;81(953):178-184. DOI: 10.1136/pgmj.2004.023846
Pali-Schöll I, Jensen-Jarolim E. Anti-acid medication as a risk factor for food allergy. Allergy. 2011;66(4):469-477. DOI: 10.1111/j.1398-9995.2010.02511.x
Piper HG. Intestinal microbiota in short bowel syndrome. Semin Pediatr Surg. 2018;27(4):223-228. DOI: 10.1053/j.sempedsurg.2018.07.007.
Sardecka I, Los-Rycharska E, Ludwing H,et al. Early risk factors for cow’s milk allergy in children in the first year of life. Allergy Asthma Proc. 2018;39(6):44-54. DOI: 10.2500/aap.2018.39.4159.
Nowak-Wegrzyn A, Katz Y, Mehr S, Koletzko S. Non-IgE-mediated gastrointestinal food allergy. J Allergy Clin Immunol. 2015;135(5):1114-1124. DOI: 10.1016/j.jaci.2015.03.025.
Hill AD, Spergel JM. The atopic march: critical evidence and clinical relevance. Ann Allergy Asthma Immunol. 2018;120(2):131-137. DOI: 10.1016/j.anai.2017.10.037
Mallol J, Crane J, von Mutius E, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) phase three: a global synthesis. Allergol Immunopathol (Madr). 2013;41(2):73-85. DOI: 10.1016/j.aller.2012.03.001
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