The Prediction of Allergic Proctocolitis by Using Hematological Parameters

Abstract

Aim: Allergic proctocolitis (AP) is a common cause of rectal bleeding in infants. There is no diagnostic tool specific to the disease. The aim of the study was to evaluate hemogram parameters as a marker of inflammation in patients with AP.

Material and Methods: The files of patients who were exclusively breastfed and diagnosed as food protein induced AP were examined retrospectively. A hundred and fifty patients diagnosed with AP were included in the study. The same number of healthy babies formed the control group. Parameters in complete blood count were compared between patient and control groups. Rectosigmoidoscopic examination was performed to confirm the diagnosis in patients who could not achieve complete improvement with diet therapy, and hemogram parameters were evaluated according to eosinophilic infiltration in biopsies.

Results: The mean platelet volume (MPV) values (p<0.001) and eosinophil percentages (p=0.001) of the AP group were higher than the control group. The mean hemoglobin values of the AP group were statistically significantly lower than the control group (p<0.001). No statistically significant difference was found between patient and control groups in terms of white blood cell (WBC) count, platelet count, platelet distribution width (PDW) and neutrophil/lymphocyte ratio (NLR). WBC count, platelet count, hemoglobin, MPV and C-reactive protein (CRP) values were similar between groups of patients according to the number of eosinophils in colon biopsies.

Conclusion: We observed a significantly higher MPV values and eosinophil percentages in patients with AP. These parameters maybe helpful in diagnosis of AP.

Keywords

• Allergy
• proctocolitis
• hemogram

Allerjik Proktokolit Öngörüsünde Hematolojik Parametrelerin Kullanımı

Öz

Amaç: Alerjik proktokolit (AP), bebeklerde görülen rektal kanamanın yaygın bir nedenidir. Bu hastalığa özgü olan bir tanı aracı yoktur. Çalışmanın amacı, AP tanısı konmuş olan hastalarda inflamasyonun bir belirteci olarak hemogram parametrelerini değerlendirmektir.

Gereç ve Yöntemler: Sadece anne sütü ile beslenen ve gıda proteini kaynaklı AP tanısı konan hastaların dosyaları geriye dönük olarak incelendi. AP tanısı konulmuş olan 150 hasta çalışmaya dahil edildi. Aynı sayıda herhangi bir sağlık sorunu saptanmayan bebek ise kontrol grubunu oluşturdu. Tam kan sayımındaki parametreler hasta ve kontrol grupları arasında karşılaştırıldı. Diyet tedavisi ile tam iyileşme sağlayamayan hastalarda tanıyı doğrulamak için ilave rektosigmoidoskopik inceleme yapıldı ve hemogram parametreleri biyopsilerdeki eozinofil infiltrasyon düzeyleri dikkate alınarak değerlendirildi.

Bulgular: AP grubunun ortalama trombosit hacmi (mean platelet volume, MPV) değerleri (p<0.001) ve eozinofil yüzdeleri (p=0.001) kontrol grubundan daha yüksekti. AP grubunun ortalama hemoglobin değerleri kontrol grubundan istatistiksel olarak anlamlı derecede daha düşüktü (p<0.001). Hasta ve kontrol grupları arasında beyaz kan hücresi (white blood cell (WBC) sayısı, trombosit sayısı, trombosit dağılım genişliği (platelet distribution width, PDW) ve nötrofil/lenfosit oranı (NLR) açısından istatistiksel olarak anlamlı bir fark bulunmadı. WBC sayısı, trombosit sayısı, hemoglobin, MPV ve C-reaktif protein (CRP) değerleri, kolon biyopsilerindeki eozinofil sayısına göre hasta grupları arasında benzerdi.

Sonuç: AP'li hastalarda anlamlı olarak yüksek MPV değerleri ve eozinofil yüzdeleri gözlendi. Bu parametreler AP tanısında yardımcı olabilir.

Anahtar Kelimeler

• Allerji
• proktokolit
• hemogram

References

1. Lake AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenetrol Nutr. 2000;30(Suppl):S58-60.
2. Maloney J, Nowak-Wegrzyn A. Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow's milk allergy. Pediatr Allergy Immunol. 2007;18(4):360-7.
3. Høst A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breast-fed infants. Incidence, pathogenetic role of early inadvertent exposure to cow’s milk formula, and characterization of bovine milk protein in human milk. Acta Paediatr Scand. 1988;77(5):663-70.
4. Machida HM, Catto Smith AG, Gall DG, Trevenen C, Scott RB. Allergic colitis in infancy: clinical and pathologic aspects. J Pediatr Gastroenterol Nutr. 1994;19(1):22-6.
5. Meyer R, Chebar Lozinsky A, Fleischer DM, Vieira MC, Du Toit G, Vandenplas Y, et al. Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-An EAACI Position Paper. Allergy. 2020;75(1):14-32.
6. Yüksel O, Helvaci K, Başar O, Köklü S, Caner S, Helvaci N, et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets. 2009;20(4):277-81.
7. Endler G, Klimesch A, Sunder-Plassmann H, Schillinger M, Exner M, Mannhalter C, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol. 2002;117(2):399-404.
8. Mimidis K, Papadopoulos V, Kotsianidis J, Filippou D, Spanoudakis E, Bourikas G, et al. Alterations of platelet function, number and indexes during acute pancreatitis. Pancreatology. 2004;4(1):22-7.

9. Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome and allergic proctocolitis. Allergy Asthma Proc. 2015;36(3):172-84.
10. Nowak-Wegrzyn A, Konstantinou G. Non-IgE-mediated food allergy: FPIES. Curr Pediatr Rep. 2014;2:135-43.
11. Feuille E, Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome, allergic proctocolitis, and enteropathy. Curr Allergy Asthma Rep. 2015;15(8):50.
12. Tanındı A, Erkan AF, Ekici B, Alhan A, Töre HF. Neutrophil to lymphocyte ratio is associated with more extensive, severe and complex coronary artery disease and impaired myocardial perfusion. Turk Kardiyol Dern Ars. 2014;42(2):125-30.
13. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.
14. Uslu AU, Deveci K, Korkmaz S, Aydin B, Senel S, Sancakdar E, et al. Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? Biomed Res Int. 2013;2013:185317.
15. Dogru M, Evcimik MF, Cirik AA. Is neutrophil-lymphocyte ratio associated with the severity of allergic rhinitis in children? Eur Arch Otorhinolaryngol. 2016;273(10):3175-8.
16. Dogru M, Yesiltepe Mutlu RG. The evaluation of neutrophil-lymphocyte ratio in children with asthma. Allergol Immunopathol (Madr). 2016;44(4):292-6.
17. Franco AT, Corken A, Ware J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood. 2015;126(5):582-8.
18. Joseph M, Capron A, Ameisen JC, Capron M, Vorng H, Pancré V, et al. The receptor for IgE on blood platelets. Eur J Immunol. 1986;16(3):306-12.
19. Capron M, Joseph M. The low affinity receptor for IgE on eosinophils and platelets. Monogr Allergy. 1991;29:63-75.
20. Nacaroglu HT, Bahceci Erdem S, Durgun E, Karaman S, Erdur CB, Unsal Karkmer CS, et al. Markers of inflammation and tolerance development in allergic proctocolitis. Arch Argent Pediatr. 2018;116(1):e1-7.
21. Dogru M, Aktas A, Ozturkmen S. Mean platelet volume increased in children with asthma. Pediatr Allergy Immunol. 2015;26(8):823-6.
22. Akgedik R, Yağız Y. Is decreased mean platelet volume in allergic airway diseases associated with extent of the inflammation area? Am J Med Sci. 2017;354(1):33-8.
23. Batmaz SB. Simple markers for systemic inflammation in pediatric atopic dermatitis patients. Indian J Dermatol. 2018;63(4):305-10.
24. Nacaroglu HT, Isguder R, Bahceci SE, Ceylan G, Korkmaz HA, Karaman S, et al. Can mean platelet volume be used as a biomarker for asthma? Postepy Dermatol Alergol. 2016;33(3):182-7.
25. Topal E, Celiksoy MH, Catal F, Karakoç HTE, Karadağ A, Sancak R. The platelet parameters as inflammatory markers in preschool children with atopic eczema. Clin Lab. 2015;61(5-6):493-6.
26. Kasperska-Zając A, Grzanka A, Jarzab J, Misiołek M, Wyszyńska-Chłap M, Kasperski J, et al. The association between platelet count and acute phase response in chronic spontaneous urticaria. Biomed Res Int. 2014;2014:650913.
27. Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT. Food allergy: the major cause of infantile colitis. Arch Dis Child. 1984;59(4):326-9.
28. Hill SM, Milla PJ. Colitis caused by food allergy in infants. Arch Dis Child. 1990;65(1):132-3.
29. Lake AM, Whitington PF, Hamilton SR. Dietary protein-induced colitis in breast-fed infants. J Pediatr. 1982;101(6):906-10.
30. Winter HS, Antonioli DA, Fukagawa N, Marcial M, Goldman H. Allergy-related proctocolitis in infants: diagnostic usefulness of rectal biopsy. Mod Pathol. 1990;3(1):5-10.
31. Goldman H, Proujansky R. Allergic proctitis and gastroenteritis in children. Clinical and mucosal biopsy features in 53 cases. Am J Surg Pathol. 1986;10(2):75-86.
32. Odze RD, Bines J, Leichtner AM, Goldman H, Antonioli DA. Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study. Hum Pathol. 1993;24(6):668-74.
33. Kapsoritakis, AN, Koukourakis MI, Sfiridaki A, Potamianos SP, Kosmadaki MG, Koutroubaki IE, et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol. 2001;96(3):776-81.
34. Öztürk, ZA, Dag MS, Kuyumcu ME, Cam H, Yesil Y, Yilmaz N, et al. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci. 2013;17(3):334-41.
35. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58.