Lymphonodular hyperplasia as a sign of food allergy in children.
BACKGROUND
Lymphonodular hyperplasia of the gastrointestinal tract in children is a rare endoscopic finding of uncertain clinical significance. In this study, 12 children with lymphonodular hyperplasia of the duodenum from a series of 63 children were studied for recurrent abdominal pain. Four additional children with lymphonodular hyperplasia of the colon are described. All the patients with lymphonodular hyperplasia were also evaluated for food allergy.


METHODS
A gastroduodenoscopy was performed in the patients with recurrent abdominal pain and in the four in whom lymphonodular hyperplasia of the colon had been diagnosed by colonoscopy. An open oral elimination and challenge test to diagnose food allergies was scheduled for all subjects with lymphonodular hyperplasia or any suspicion of food allergy. The study design also included skin prick tests with common allergens and determination of serum immunoglobulin A and immunoglobulin E concentrations.


RESULTS
Lymphonodular hyperplasia of the duodenal bulb was the main finding in 12 (19%) of the 63 children. The condition was found to be associated with food allergy in nine subjects (75%), which was significantly more often than among the remaining 51, 12 (24%) of whom had food allergy by the same criteria. In an oral challenge, food allergy first manifested gastrointestinal symptoms in the subjects of both groups and, in all except one, on days 2 through 5 after the foodstuffs were administered in minimal doses. In a histologic study, the duodenal specimens revealed significantly more eosinophilic cells in the children with food allergy and lymphonodular hyperplasia than in the children with food allergy but no lymphonodular hyperplasia. The major symptoms in the four patients with lymphonodular hyperplasia of the colon had been anemia and blood in stool in two and abdominal pains with mucous loose stools in the remaining two. Colonoscopic examination showed one to have diffuse and the other three patchy lymphonodular hyperplasia of the colon. In an oral challenge, three reacted to milk and two to cereals.


CONCLUSIONS
Preliminary observations showed that lymphonodular hyperplasia of the duodenum or the colon is related to the gastrointestinal type of food allergy to basic foodstuffs. Further research is needed to define this finding as a separate entity.
Department of Pediatrics, University Hospital, Oulu, Finland.
J
J
Kokkonen
T J
TJ
Karttunen
A
A
Niinimäki
D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006965:Hyperplasia; D007223:Infant; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male