Teste cutâneo de leitura tardia no diagnóstico em pacientes com suspeita de proctocolite eosinofílica

Abstract

Eosinophilic proctocolitis is a clinical manifestation of food allergy non-IgE mediated and characterized by the presence of blood in stool due to lesions generally restricted to the distal colon. The diagnosis is confirmed by oral food challenge test, considered the gold standard in the diagnosis of food allergies. Previous studies recommend the inclusion of atopy patch test as complementary test in patients with suspected food allergy that also present other gastrointestinal symptoms. The aim of this study was to evaluate the use of the atopy patch test in the diagnosis of eosinophilic proctocolitis. A prospective cross-sectional study was performed on clinically normal infants with small fresh rectal bleeding with duration longer than 4 days. After 4 weeks of cow\'s milk exclusion, the atopy patch test was performed on the children with cow\'s fresh milk, cow\'s milk at 3.5% diluted in saline water and cow\'s milk diluted to 3.5% petrolatum, and subsequently performed the oral food challenge test with polymeric formula based on cow\'s milk to confirm the diagnosis and to construct the contingency table and calculate sensitivity, specificity, positive predictive value and negative predictive value. Infant feeding type, breastfeeding, child\'s age when the formula was introduced, age when symptoms started to appear, weight and height were also investigated. Out of the 31 children who were analyzed, the average age was 97.0 days and 58.1% were male. 90.0% of infants were delivered by caesarean section and 60.0% with gestational age over 38 weeks. The average duration of breastfeeding was 166.4 days (13.3% were exclusively breastfed, 70.0% were mixed-fed and 16.7% were formula-fed). Eleven children (36.7%) continued to receive breast milk even after the diagnostic process had been completed. Out of all infants, 70.0% received infant formula in the nursery. On admission, the average weight and average height was 5699 g and 59.1 cm, respectively. The average age of when the symptoms started to appear as reported by the parents was 46.5 days. All children had negative atopy patch tests, however cow\'s milk food allergy was confirmed in six children (19.3%) using oral food challenge test. Therefore, the atopy patch test does not seem to be an appropriate instrument to be used in the diagnosis of eosinophilic proctocolitis.