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Allergieassoziierte Kolitis

Charakterisierung einer Entität und ihr differenzialdiagnostisches Spektrum

Zusammenfassung

Die Manifestation einer gastrointestinal vermittelten Allergie bedeutet aufgrund des äußerst variablen klinischen Bildes, der überlappenden Symptomatik mit anderen Erkrankungen des Gastrointestinaltrakts und des Fehlens eines eindeutigen diagnostischen Verfahrens eine Herausforderung für den behandelnden Arzt. Trotz einer Reihe von neueren Untersuchungen über die Funktion der eosinophilen Granulozyten bei Erkrankungen des Gastrointestinaltrakts ist bisher über ihre Bedeutung in der Pathophysiologie gastrointestinal vermittelter Allergien wenig bekannt. Einige Ergebnisse implizieren eine Beteiligung der Eosinophilen an allergischen Reaktionen des Darmes. Die histologischen Veränderungen bei einer nahrungsmittelallergieassoziierten Diarrhö an Schleimhautbiopsien aus dem unteren Gastrointestinaltrakt werden dominiert von einem Eosinophileninfiltrat im Bereich von Lamina propria, Oberflächen- und Kryptenepithel sowie Submukosa mit Degranulation der eosinophilen Granulozyten. Zur Darstellung und Einschätzung der eosinophilen Granulozyten hinsichtlich Dichte und Degranulation ist eine immunhistochemische Zusatzanalyse mit einem kommerziell erhältlichen Antikörper gegen Eosinophilenperoxidase hilfreich. Trotz charakteristischer histologischer Veränderungen kann die Diagnose einer gastrointestinal vermittelten Allergie erst nach Ausschluss einer Reihe von Differenzialdiagnosen und aufgrund eines dezidierten diagnostischen Vorgehens gestellt werden.

Abstract

There is substantial evidence that allergic reactions exist in the gastrointestinal tract (GI). However, patients with food allergy-related enteropathy pose a diagnostic challenge to physicians because the clinical features are variable, unspecific, occur in other gastrointestinal disorders, and specific diagnostic tools are missing. Several recent studies and reviews have focused on the function of eosinophilic granulocytes in GI disease. The role of eosinophils in the pathophysiology of GI hypersensitivity reactions is poorly defined. However, some findings have been reported that imply an involvement of eosinophils in allergic reactions of the gut. The presumptive histology of allergy-associated colitis in colonic and ileal biopsies is based on prominent pure eosinophilic infiltration of a normal lamina propria, submucosa and epithelium with variable degrees of degranulation. An immunoperoxidase stain for eosinophilic peroxidase is supportive in establishing the diagnosis if suspected. Neutrophils or mononuclear infiltrates are not significantly increased and damage to the intestinal tissue is not prominent. Despite characteristic histologic changes in colonic biopsy specimens, a final diagnosis depends on careful clinical examination and exclusion of several differential diagnoses.

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Correspondence to Susanna Müller.

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Müller, S., Schwab, D., Aigner, T. et al. Allergieassoziierte Kolitis. Pathologe 24, 28–35 (2003). https://doi.org/10.1007/s00292-002-0604-7

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Schlüsselwörter

  • Nahrungsmittelallergie
  • Chronisch-entzündliche Darmerkrankung
  • Eosinophile
  • Immunhistochemie

Keywords

  • Food allergy
  • Inflammatory bowel disease
  • Eosinophils
  • Immunohistochemistry