Lymphonodular hyperplasia as a sign of food allergy in children

Background: Lymphanodular hyperplasia of the gastrointestinal tract in chil dren is a rare endoscopic finding of uncertain clinical significance. In th is study, 12 children with lymphonodular hyperplasia of the duodenum from a series of 63 children were studied for recurrent abdominal pain. Four addi tional children with lymphonodular hyperplasia of the colon are described. All the patients with lymphonodular hyperplasia were also evaluated for foo d allergy. Methods: A gastroduodenoscopy was performed in the patients with recurrent abdominal pain and in the four in whom lymphonodular hyperplasia of the col on had been diagnosed by colonoscopy. An open oral elimination and challeng e test to diagnose food allergies was scheduled for all subjects with lymph onodular hyperplasia or any suspicion of food allergy. The study design als o included skin prick tests with common allergens and determination of seru m immunoglobulin A and immunoglobulin E concentrations. Results: Lymphonodular hyperplasia of the duodenal bulb was the main findin g in 12 (19%) of the 63 children. The condition was found to be associated with food allergy in nine subjects (75%), which was significantly mon 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 gastrointest inal symptoms in the subjects of both groups and, in all except one, on day s 2 through 5 after the foodstuffs were administered in minimal doses. In a histologic study, the duodenal specimens revealed significantly more eosin ophilic cells in the children with food allergy and lymphonodular hyperplas ia 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 wit h mucous loose stools in the remaining two. Colonoscopic examination showed one to have diffuse and the other three patchy lymphonodular hyperplasia o f the colon. In an oral challenge, three reacted to milli and two to cereal s. Conclusions: Preliminary observations showed that lymphonodular hyperplasia of the duodenum or the colon is related to the gastrointestinal type of fo od allergy to basic foodstuffs. Further research is needed to define this f inding as a separate entity.