Severe food-induced vasculitis in two children

Food-induced vasculitis seems to be rare and is considered by some as controversial. The reported cases in the literature are few and mostly on adult patients. Described in this report are two children with severe vasculitis caused by specific foods. They were diagnosed at two separate allergy centers that have a special interest in food allergies. Case 1 was an 8-year-old girl with a 9-month history of cutaneous vasculitis with large joints involvement. Case 2 was a 23-month-old girl with an 8-month history of multiple hospitalizations for recurrent acute severe cutaneous and mucous membrane vasculitis with large joints involvement. In both patients. skin biopsy showed leucocytoclastic vasculitis. In neither of the patients could the symptoms be attributed to drug intake, infection, autoimmunity, or other systemic disease. Case 1 had a moderately elevated serum total immunoglobulin E (IgE) level and strongly positive skin test and radioallergosorbent test (RAST) to cow's milk and hen's egg, both of which were proven to be the cause by elimination-challenge tests. Case 2 had a slightly elevated serum total IgE level, but negative skin tests to foods, including chocolate that was suspected by the mother. Avoidance of chocolate resulted in remission, except following accidental investigation cocoa-containing products. These findings support the few previous reports on food-induced vasculitis, an entity that seems rare but may be more commn than currently realized

New therapeutic approach in the management of intestinal disease: probiotics in intestinal disease in paediatric age

Current evidence supports the view that oral administration of probiotics may be of therapeutic usefulness in several clinical disorders by reestablishing normal flora in the gastrointestinal tract. These entities include inflammatory and infectious diseases of the gut as well as extraintestinal disorders [such as atopic eczema] in which a defective intestinal permeability plays a role. The probiotic effects are attributed to restoration to normal of increased intestinal permeability, unbalanced gut microecology, improved immunological gut barrier function, downregulation of the intestinal inflammatory responses with reduced generation of proinflammatory cytokines. Entities for which the impact of probiotic administration can be considered as proven are Rotavirus diarrhoea, Clostridium difficile diarrhoea, post-antibiotic diarrhoea, allergic diseases. On the other hand, entities for which administration of probiotics is considered under investigation are inflammatory bowel disease, necrotizing enterocolitis, cystic fibrosis, small bowel bacterial contamination, functional gastrointestinal disorders. The value of probiotics as therapy for a variety of gastrointestinal disorders in childhood still needs to be investigated in detail, through well controlled and rigorous studies, including a placebo group and strict criteria of randomisation. Much work needs to be done in this area by clearly defining indications, delivery system, costs, safety, long-term effects

Infliximab induces healing of inflammatory lesions of the gut and restores growth in childrenwith severe refractory Crohn’s disease.

In: Dig Liver Disease 2003, 35 (10) p S3, Abs 7, AMSTERDAM: Elsevier doi: 10.1016/S1590-8658(03)00464-

Contrast-enhanced magnetic resonance imaging (MRI) of the distal small bowel in children with Chron's disease

JPGN 2002; vol 34, No. 4, pg 446, No.

5-Aminosalicylates and Renal Function in Children with Inflammatory Bowel Disease

Introduction: drugs containing 5-ASA (aminosalicylates) are widely used in the management of inflammatory bowel disease (IBD) both for treating the active phases and maintaining remission. The use of these agents has been associated with the risk of developing a tubuleinterstitial nephritis although the presence of this injury in IBD patients (pts) who had never received 5-ASA has been reported. There are no studies on the renal function of children with IBD receiving 5-ASA Aim: in a group of children with IBD on 5-ASA therapy we have assessed the renal function and its relationship to the cumulative dose of 5-ASA, disease duration and activity indexes (PCDAI for CD, PUCAI for UC). Methods: We enrolled 23 consecutive children (10 female) (mean age [SD]: 10.0 [5.6] years) with ulcerative colitis (UC), and 13 children (7 female) (mean age [SD]: 12.0 [4.3] years) with Crohn's disease (CD). All were referred to our Department with a diagnosis of IBD for re-evaluation of their condition. All were receiving only 5-ASA. Renal function test was performed by obtaining a 24-hour urine collection and a blood sample drawn at the end of the urine collection. Glomerular filtration rate, fractional excretion of sodium, tubular reabsorption of phosphate and proteinuria were measured. The total drug dose, the total drug dose/kg and the total drug dose/kg/month of therapy were also calculated. Pts were subdivided in two groups on the basis of the proteinuria level, 150mg/die (group B): the latter were compared for renal function, drug dose, and disease duration. Difference between groups was analyzed with non-parametric test (Wilcoxon test) (p 150 mg/ die). A and B groups did not differ for renal function parameters, total drug dose taken, total drug dose/kg and the total drug dose/kg/month of therapy. The disease duration (months) was significantly shorter in children with a proteinuria >150mg/die (CD; A: 48.5±53.6, B: 20.1±9.6 - UC; A: 31.3±33.4, B: 20.2±31.1). The level of proteinuria significantly correlated with the acitivity of disease both for CD (r: 0.77, p<0.01) and for UC (r:0.69, p<0.01). Conclusions: in children with IBD chronic 5-ASA administration does not cause proteinuria; the latter appears to be related to the disease activity. It is suggested that proteinuria can be a feature of extra-intestinal involvement of IBD