title: Characteristics of allergic colitis in breast-fed infants in the absence of cow's milk allergy.
abstract: OBJECTIVE
  To investigate the characteristics of mucosal lesions and their relation to laboratory data and long-term follow up in breast-fed infants with allergic colitis.
  
  
  METHODS
  In this study 31 breast-fed infants were prospectively evaluated (mean age, 17.4 wk) whose rectal bleeding had not ceased after a maternal elimination diet for cow's milk. Thirty-four age-matched and breast-fed infants (mean age, 16.9 wk) with no rectal bleeding were enrolled for laboratory testing as controls. Laboratory findings, colonoscopic and histological characteristics were prospectively evaluated in infants with rectal bleeding. Long-term follow-up with different nutritional regimes (L-amino-acid based formula or breastfeeding) was also included.
  
  
  RESULTS
  Iron deficiency, peripheral eosinophilia and thrombocytosis were significantly higher in patients with allergic colitis in comparison to controls (8.4 ± 3.2 μmol/L vs 13.7 ± 4.7 μmol/L, P < 0.001; 0.67 ± 0.49 G/L vs 0.33 ± 0.17 G/L, P < 0.001; 474 ± 123 G/L vs 376 ± 89 G/L, P < 0.001, respectively). At colonoscopy, lymphonodular hyperplasia or aphthous ulceration were present in 83% of patients. Twenty-two patients were given L-amino acid-based formula and 8 continued the previous feeding. Time to cessation of rectal bleeding was shorter in the special formula feeding group (mean, 1.4 wk; range, 0.5-3 wk) when compared with the breast-feeding group (mean, 5.3 wk; range, 2-9 wk). Nevertheless, none of the patients exhibited rectal bleeding at the 3-mo visit irrespective of the type of feeding. Peripheral eosinophilia and cessation of rectal bleeding after administration of elemental formula correlated with a higher density of mucosal eosinophils.
  
  
  CONCLUSIONS
  Infant hematochezia, after cow's milk allergy exclusion, is generally a benign and probably self-limiting disorder despite marked mucosal abnormality. Formula feeding results in shorter time to cessation of rectal bleeding; however, breast-feeding should not be discouraged in long-lasting hematochezia.
authors.affiliation: 1st Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary.
authors.forename: Kriszta
authors.initials: K
authors.lastname: Molnár
authors.forename: Petra
authors.initials: P
authors.lastname: Pintér
authors.forename: Hajnalka
authors.initials: H
authors.lastname: Győrffy
authors.forename: Aron
authors.initials: A
authors.lastname: Cseh
authors.forename: Katalin Eszter
authors.initials: KE
authors.lastname: Müller
authors.forename: András
authors.initials: A
authors.lastname: Arató
authors.forename: Gábor
authors.initials: G
authors.lastname: Veres
mesh_terms: D000818:Animals; D003092:Colitis / Q000150:complications*; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008892:Milk / Q000009:adverse effects*; D016269:Milk Hypersensitivity / Q000150:complications*; D008895:Milk, Human; D011446:Prospective Studies; D013997:Time Factors
keywords: Allergic colitis; Amino-acid formula; Breast-feeding; Colonoscopy; Rectal bleeding