Histological findings in infants with Gastrointestinal food allergy are associated with specific gastrointestinal symptoms; retrospective review from a tertiary centre.

BACKGROUND: Gastrointestinal food allergy (GIFA) occurs in 2 to 4 % of children, the majority of whom are infants (85 % (OR > 5.67) of having abnormal histological findings compared to those without. Those with isolated PR bleeding or diarrhoea were associated with 74 % and 68 % probability (OR: 2.85 and 2.13) of an abnormal biopsy, respectively. Conversely, children presenting with faltering growth or reflux/vomiting showed any abnormal mucosal histology in only 50.8 % and 45.3 % (OR: 1.04 and 0.82) respectively. CONCLUSIONS: Food allergy may occur in very young children and is difficult to diagnose. Since endoscopy in infants has significant risks, stratification of decision-making may be aided by symptoms. At least one mucosal biopsy demonstrated an abnormal finding in around half of cases in this selected population. Infants presenting with diarrhoea, PR bleeding, urticaria and irritability are most likely to demonstrate abnormal histological findings

Epidemiology

Gastroesophageal reflux (GER) is very common among preterm infants, but its real frequency is not well established. GER may be obvious, manifesting with regurgitations or emesis or more difficult to detect when associated with general symptoms such as apnea, bradycardia, pallor, oxygen desaturation, severe malaise, feeding difficulties with weight loss or poor growth (failure to thrive), crying, hematemesis, and melena. The origin probably resides in motor problems in some and in cow's milk allergy in others. Diagnosis is difficult to make, in the absence of reference values. Impedancemetry coupled to a pH probe is interesting since reflux is frequently nonacid. The treatment should always be conservative and stepwise. None of the drugs used are licensed in this age range and some have severe adverse effect