RESUMEN
Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, alpha-lactoalbumin, beta-lactoglobulin, and a food group; and skin-prick tests with whole milk, alpha-lactoalbumin, beta-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48-72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.
Asunto(s)
Estreñimiento/etiología , Hipersensibilidad a la Leche/complicaciones , Niño , Preescolar , Enfermedad Crónica , Humanos , Inmunoglobulina E/sangre , Lactante , Hipersensibilidad a la Leche/sangre , Prueba de Radioalergoadsorción , Pruebas CutáneasAsunto(s)
Traslocación Bacteriana , Infecciones por Escherichia coli/fisiopatología , Escherichia coli , Intestino Delgado/microbiología , Choque Séptico/fisiopatología , Animales , Escherichia coli/aislamiento & purificación , Escherichia coli/fisiología , Infecciones por Escherichia coli/mortalidad , Intestino Delgado/fisiopatología , Ratas , Ratas Wistar , Choque Séptico/mortalidad , Tasa de SupervivenciaAsunto(s)
Adhesión Bacteriana/fisiología , Traslocación Bacteriana/fisiología , Endotelio Vascular/microbiología , Infecciones por Escherichia coli/fisiopatología , Escherichia coli/fisiología , Animales , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Vena Porta , Venas Pulmonares , Ratas , Ratas Wistar , Venas Renales , Vena Cava InferiorRESUMEN
OBJECTIVE: Malabsorption of iron has been reported in children with symptomatic giardiasis. The aim of this study was to evaluate intestinal absorption of iron in children with asymptomatic giardiasis and iron deficiency anemia. SUBJECTS: Based upon results of blood hemoglobin and stool examination, two groups were established: asymptomatic giardiasis and anemia, and anemia without intestinal parasitosis (control group). Patients were aged 1-6 years. There was no difference in age, weight, height, or iron nutritional status between the asymptomatic giardiasis and control groups on admission to the study. MEASURES: Intestinal absorption of iron was evaluated using the iron tolerance test and the hemoglobin response to iron therapy. The serum iron tolerance test was based on the increment of iron level 2 hours after administering an iron load of 1 mg/kg of elemental iron in the form of ferrous sulfate, in comparison to the fasting iron level. Hemoglobin response to oral iron therapy was determined by the increment of hemoglobin on day 30 of therapy with ferrous sulfate (5 mg/kg/day of elemental iron). RESULTS: There was no statistical difference between the asymptomatic giardiasis and control groups with reference to the iron tolerance test (159.1 +/- 73.1 micrograms/dl and 154.5 +/- 76.5 micrograms/dl, respectively) and to the hemoglobin response to iron therapy (1.5 +/- 0.7 g/dl and 1.8 +/- 1.1 g/dl, respectively). The presence or absence of trophozoites of Giardia lamblia on duodenal aspirate did not affect intestinal absorption of iron. CONCLUSION: Asymptomatic giardiasis did not affect the intestinal absorption of iron and the hemoglobin response to oral iron therapy in iron-deficient anemic children.