446:
Significant comorbidity of necrotizing enterocolitis with non-IgE-mediated gastrointestinal food allergy in non-premature babies
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Yumiko Miyaji, MD, PhD, Tatsuki Fukuie, MD, PhD, Masami Narita, MD, PhD, Yukihiro Ohya, MD PhD, Kenji Matsumoto, MD PhD, Ichiro Nomura, MD, PhD
RATIONALE: Necrotizing enterocolitis (NEC) is a life-threatening disease during the neonatal period, but its pathogenesis is mostly unknown. A systematic review was performed to identify relationships between NEC and non-IgE-mediated gastrointestinal food allergy (GI allergy).

METHODS: Using electronic databases such as PubMed and Igaku Chuo Zasshi (Japan’s largest peer-reviewed medical literature database), we searched from 2000 to 2017 for case reports/series of babies who (1) underwent emergency laparotomy due to NEC and (2) were diagnosed with GI allergy based on identification eosinophilia in the stool mucous and/or eosinophilia in the intestinal mucosa (>20/HPF).

RESULTS: A total of 95 babies in 33 papers were identified as having undergone emergency laparotomy due to NEC. Among them, 7 babies (7.3%) satisfied the inclusion criteria for GI allergy (2 babies with marked GI mucosal eosinophilia and 5 with eosinophilia in the stool mucous). In all 7 babies the onset of GI allergy preceded the onset of NEC. This prevalence was significantly higher than that reported for GI allergy in the general population (0.21%). NEC babies without GI allergy (gestational age: median 25.3 W (IQR: 24.1-27.0 W); birth weight: median 696 g (IQR: 590-831 g)) were significantly (p<0.0001) more premature than those with GI allergy (gestational age: median 35 W (IQR: 32-37 W); birth weight: median 1,794 g (IQR: 1,252-2,070 g)).

CONCLUSIONS: Although there is no clear direct causal relationship, NEC in non-premature babies showed significant comorbidity with GI allergy. GI allergy’s role in the pathogenesis of NEC warrants further study.