Pediatrician (St. Petersburg)Pediatrician (St. Petersburg)Педиатр2079-78502587-6252Eco-Vector885510.17816/PED9271-77ArticlesСтатьиResearch ArticleIrritable bowel syndrome and food allergy in childrenСиндром раздраженной кишки и пищевая аллергия у детейNovikovaValeria P.НовиковаВалерия Павловна
Russian Federation

MD, PhD, Dr Med Sci, Professor, Head, Laboratory of Medical and Social Problems in Pediatrics, Research Center

д-р мед. наук, профессор, заведующая лабораторией медико-социальных проблем в педиатрии, НИЦ

novikova-vp@mail.ruRevnovaMaria O.РевноваМария Олеговна
Russian Federation

MD, PhD, Dr Med Sci, Professor, Head, Department of Outpatient Pediatrics n.a. A.F. Tour

д-р мед. наук, профессор, заведующая кафедрой поликлинической педиатрии им. А. Ф. Тура

revnoff@mail.ruListopadovaAnastasia P.ЛистопадоваАнастасия Павловна
Russian Federation

MD, PhD, Senior Researcher, Laboratory of Medical and Social Problems in Pediatrics, Research Center

канд. мед. наук, старший научный сотрудник, лаборатория медико-социальных проблем в педиатрии, НИЦ

a.listopadova@mail.ruSt. Petersburg State Pediatric Medical UniversityФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России1505201892VOL 9, NO2 (2018)ТОМ 9, №2 (2018)717721052018Copyright ©; 2018, Novikova V.P., Revnova M.O., Listopadova A.P.Copyright ©; 2018, Новикова В.П., Ревнова М.О., Листопадова А.П.2018Novikova V.P., Revnova M.O., Listopadova A.P.Новикова В.П., Ревнова М.О., Листопадова А.П.http://creativecommons.org/licenses/by/4.0https://journals.eco-vector.com/pediatr/article/view/8855

Dysplasia of the main veins (DMV) is known by the names of authors had described this pathology as the Klippel-Trenone syndrome (KTS). Many authors consider the cause of the syndrome to be the impact of various teratogenic factors. These include drugs, infectious agents, radiation exposure, domestic and occupational hazards. Teratogenic factors can damage embryo vessels, causing local stasis and hemorrhages, which can be cause for the perverse formation of veins and surrounding tissues. The clinical picture of severe and extremely severe degrees embryonic type DMV is quite simple. It include asymmetric hypertrophy of the extremities, “disfiguring” in patients with extremely severe degree, extensive cyanotic vascular spots, often accompanied by papillomatous nevus of the skin. The spots are located on the anterolateral surface of the thigh and lower leg. Embryonic veins, which can be found under the spots – a characteristic pathognomonic sign of the KTS. Disturbances in the shape of the limb and external signs of angiodysplasia (vascular spots, atypical veins) in children with mild to moderate severity degree are less pronounced and can be inconstant. Examination and treatment of children with DMV, depending on the severity of the lesion, it is rational to start from the time of detection to 6 years. Phlebography reveal various variants of violation of the surgical anatomy of the veins of the affected limbs. Medium and light forms of dysplasia of the main veins should be differentiated with similar forms of fetal type, congenital Parkes Weber syndrome and acquired iliofemoral thrombosis (atypical veins above the bosom). Sometimes there are combinations of dysplasia of the main, deep, intermuscular and superficial veins. The following operations, according to the indications, are performed: phlebectomy and perforant veins ligation; embryonic veins removal and main outflow correction; musculoskeletal system surgery, abdominal and retroperitoneal surgery, as well as amputation of affected limb. Treatment including surgical and non-surgical methods should be comprehensive and should be performed in highly specialized, multidisciplinary hospitals.

Дисплазия магистральных вен (ДМВ) известна по именам авторов, описавших данную патологию, как синдром Клиппеля – Треноне (КТС). Многие исследователи считают причиной развития синдрома воздействие различных тератогенных факторов. К ним относят лекарственные препараты, возбудители инфекционных заболеваний, радиационное воздействие, бытовые и профессиональные вредности. Тератогенные факторы могут повреждать сосуды зародыша, вызывая локальные стазы и кровоизлияния, достаточные для неправильного формирования вен и окружающих тканей. Клиническая картина ДМВ эмбрионального типа крайне тяжелой и тяжелой степеней поражения довольно проста. Осмотр выявляет несимметричную гипертрофию конечностей, «уродующую» пациентов с крайне тяжелой степенью нарушения, обширные сосудистые пятна синюшной окраски, нередко с папилломатозной поверхностью. Пятна располагаются по передненаружной поверхности бедра и голени. В проекции пятен обнаруживают эмбриональные вены — характерный патогномоничный признак КТС. Нарушения формы конечности и внешние признаки ангиодисплазии (сосудистые пятна, атипичные вены) у детей со средней и легкой степенями поражения менее выражены и непостоянны. Обследование и лечение детей с ДМВ в зависимости от тяжести поражения рационально начинать с момента выявления (до 6 лет). При помощи вазоконтрастных методов диагностики удается установить различные варианты нарушения хирургической анатомии вен пораженных конечностей. Средние и легкие формы дисплазии магистральных вен следует дифференцировать с аналогичными формами фетального типа, врожденными микрофистулами (синдром Паркса – Вебера) и приобретенными илиофеморальными тромбозами (атипичные вены над лоном). Иногда наблюдается сочетание дисплазии магистральных, глубоких, поверхностных и межмышечных вен. По показаниям выполняют следующие операции: удаление измененных поверхностных вен и перевязка перфорантных вен; удаление эмбриональных вен и коррекция магистрального оттока; оперативные вмешательства на опорно-двигательном аппарате, на органах брюшной полости и забрюшинного пространства, а также ампутации. Лечение должно быть комплексным и проводиться на базе многопрофильных высокоспециализированных учреждений при использовании хирургических и нехирургических методов.

irritable bowel syndromefood allergychildrenсиндром раздраженной кишкипищевая аллергиядетиБарановский А.Ю., Кондрашина Э.А. Дисбактериоз и дисбиоз кишечника. - СПб., 2000. [Baranovskij AYu, Kondrashina EA. Disbakterioz i disbioz kishechnika. Saint Petersburg; 2000. (In Russ.)]Барановский А.Ю., Кондрашина Э.А. Дисбактериоз и дисбиоз кишечника. Сер. «Краткое руководство» (2-е изд., исправл.). - СПб., 2002. [Baranovskij AYu, Kondrashina EA. Disbakterioz i disbioz kishechnika. Ser. “Kratkoe rukovodstvo” (2nd edition). Saint Petersburg; 2002. (In Russ.)]Бельмер С.В.,Хавкин А.И., Печкуров Д.В. Функциональные расстройства органов пищеварения у детей (в свете Римских критериев IV). - М.: Ремдер, 2016. [Bel'mer SV, Khavkin AI, Pechkurov DV. Functional disorders of the digestive system in children (in light of the Rome criteria IV). Moscow: Remder; 2016. (In Russ.)]Васильев Б.Я., Васильева Р.И., Лобзин Ю.В. Острые кишечные заболевания: ротавирусы и ротавирусная инфекция. - СПб., 2000. [Vasilev BYa, Vasileva RI, Lobzin YuV. Ostrye kishechnye zabolevaniya: rotavirusy i rotavirusnaya infekciya. Saint Petersburg; 2000. (In Russ.)]Гурина О.П., Дементьева Е.А., Блинов А.Е., и др. Особенности иммунного реагирования при атопии у детей // Педиатр. - 2014. - Т. 5. - № 4. - С. 95-103. Gurina OP, Dement'yeva EA, Blinov AE, et al. Characteristics of the immune response in children with atopic disorders. Pediatrician (St. Petersburg). 2014;5(4):95-103. (In Russ.)]Намазова-Баранова Л.С., Алексеева А.А., Алтунин В.В., и др. Аллергия у детей: от теории - к практике. - М., 2011. [Namazova-Baranova LS, Alekseeva AA, Altunin VV, et al. Allergiya u detej: ot teorii - k praktike. Moscow; 2011. (In Russ.)]Саблин О.А., Гриневич В.Б., Успенский Ю.П., Ратников В.А. Функциональная диагностика в гастроэнтерологии: Учебно-методическое пособие. - СПб., 2002. [Sablin OA, Grinevich VB, Uspenskij YuP, Ratnikov VA. Funkcionalnaya diagnostika v gastroenterologii. Uchebno-metodicheskoe posobie. Saint Petersburg; 2002. (In Russ.)]André F, André C, Colin L, Cavagna S. IgE in stools as indicator of food sensitization. Allergy. 1995;50(4):328-33. doi: 10.1111/j.1398-9995.1995.tb01156.x.Aydinlar EI, Dikmen PY, Tiftikci A, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013;53(3):514-525. doi: 10.1111/j.1526-4610.2012.02296.x.Arslan G, Gilja OH, Lind R, et al. Response to intestinal provocation monitored by transabdominal ultrasound in patients with food hypersensitivity. Scand J Gastroenterol. 2009;40(4):386-394. doi: 10.1080/00365520510012163.Arslan G, Lillestol K, Mulahasanovic A, et al. Food hypersensitivity reactions visualised by ultrasonography and magnetic resonance imaging in a patient lacking systemic food-specific IgE. Digestion. 2006;73(2-3): 111-115. doi: 10.1159/000094042.Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004;53(10): 1459-1464. doi: 10.1136/gut.2003.037697.Barbara G, Stanghellini V, De Giorgio R, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004;126(3):693-702. doi: 10.1053/j.gastro.2003.11.055.Braak B, Klooker TK, Wouters MM, et al. Mucosal immune cell numbers and visceral sensitivity in patients with irritable bowel syndrome: is there any relationship? Am J Gastroenterol. 2012;107(5):715-26. doi: 10.1038/ajg.2012.54.Brito-Zeron P, Ramos-Casals M, Bosch X, Stone JH. The clinical spectrum of IgG4-related disease. Autoimmun Rev. 2014;13(12):1203-1210. doi: 10.1016/j.autrev.2014.08.013.Bischoff SC, Herrmann A, Manns MP. Prevalence of adverse reactions to food in patients with gastrointestinal disease. Allergy. 1996;51(11):811-818. doi: 10.1111/j.1398-9995.1996.tb04471.x.Bousquet J, Cabrera P, Berkman N, et al. The effect of treatment with omalizumab, an anti-IgE antibody, on asthma exacerbations and emergency medical visits in patients with severe persistent asthma. Allergy. 2005;60(3):302-308. doi: 10.1111/j.1398-9995.2004.00770.x.Cole JA, Rothman KJ, Cabral HJ, et al. Incidence of IBS in a cohort of people with asthma. Dig Dis Sci. 2007;52(2): 329-335. doi: 10.1007/s10620-006-9530-5.Drisko J, Bischoff B, Hall M, McCallum R. Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics. J Am Coll Nutr. 2006;25(6):514-522. doi: 10.1080/07315724.2006.10719567.Fälth-Magnusson K, Kjellman NIM, Magnusson KE. Antibodies IgG, IgA, and IgM to food antigens during the first 18 months of life in relation to feeding and development of atopic disease. J Allergy Clin Immunol. 1988;81(4):743-749. doi: 10.1016/0091-6749(88)91048-2.Fritscher-Ravens A, Schuppan D, Ellrichmann M, et al. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology. 2014;147(5):1012-1020 e1014. doi: 10.1053/j.gastro.2014.07.046.Guilarte M, Santos J, de Torres I, et al. Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum. Gut. 2007;56(2):203-9. doi: 10.1136/gut.2006.100594.Guo H, Jiang T, Wang J, et al. The value of eliminating foods according to food-specific immunoglobulin G antibodies in irritable bowel syndrome with diarrhoea. J Int Med Res. 2012;40(1):204-210. doi: 10.1177/147323001204000121.Hunskar GS, Langeland N, Wensaas KA, et al. The impact of atopic disease on the risk of post-infectious fatigue and irritable bowel syndrome 3 years after Giardia infection. A historic cohort study. Scand J Gastroenterol. 2012;47(8-9):956-961. doi: 10.3109/00365521.2012.696681.Pearson JS, Niven RM, Meng J, et al. Immunoglobulin E in irritable bowel syndrome: another target for treatment? A case report and literature review. Therap Adv Gastroenterol. 2015;8(5):270-277. doi: 10.1177/1756283X15588875.Jones MP, Walker MM, Ford AC, Talley NJ. The overlap of atopy and functional gastrointestinal disorders among 23,471 patients in primary care. Aliment Pharmacol Ther. 2014;40(4):382-391. doi: 10.1111/apt.12846.Johansson SG, Dannaeus A, Lilja G. The relevance of anti-food antibodies for the diagnosis of food allergy. Ann Allergy. 1984;53(6 Pt 2):665-672.Jun D-W. Food intolerance and skin prick test in treated and untreated irritable bowel syndrome. World J Gastroenterol. 2006;12(15):2382. doi: 10.3748/wjg.v12.i15.2382.Kamisawa T, Zen Y, Pillai S, Stone JH. IgG4-related disease. Lancet. 2015;385(9976):1460-1471. doi: 10.1016/s0140-6736(14)60720-0.Klooker TK, Braak B, Koopman KE, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut. 2010;59(9):1213-1221. doi: 10.1136/gut.2010.213108.Kristjansson G, Serra J, Loof L, et al. Kinetics of mucosal granulocyte activation after gluten challenge in coeliac disease. Scand J Gastroenterol. 2005;40(6): 662-669. doi: 10.1080/00365520510015566.Laukoetter MG, Nava P, Nusrat A. Role of the intestinal barrier in inflammatory bowel disease. World J Gastroenterol. 2008;14(3):401. doi: 10.3748/wjg.14.401.Lee H, Park JH, Park DI, et al. Mucosal mast cell count is associated with intestinal permeability in patients with diarrhea predominant irritable bowel syndrome. J Neurogastroenterol Motil. 2013;19(2):244-250. doi: 10.5056/jnm.2013.19.2.244.Liden M, Kristjansson G, Valtysdottir S, et al. Cow's milk protein sensitivity assessed by the mucosal patch technique is related to irritable bowel syndrome in patients with primary Sjogren's syndrome. Clin Exp Allergy. 2008;38(6):929-935. doi: 10.1111/j.1365-2222.2008.02983.x.Ligaarden SC, Lydersen S, Farup PG. IgG and IgG4 antibodies in subjects with irritable bowel syndrome: a case control study in the general population. BMC Gastroenterol. 2012;12:166. doi: 10.1186/1471-230X-12-166.Lillestol K, Helgeland L, Arslan Lied G, et al. Indications of 'atopic bowel' in patients with self-reported food hypersensitivity. Aliment Pharmacol Ther. 2010;31(10):1112-1122. doi: 10.1111/j.1365-2036.2010.04261.x.Macsharry J, O'Mahony L, Fanning A, et al. Mucosal cytokine imbalance in irritable bowel syndrome. Scand J Gastroenterol. 2008;43(12):1467-1476. doi: 10.1080/00365520802276127.Mekkel G, Barta Z, Ress Z, et al. Increased IgE-type antibody response to food allergens in irritable bowel syndrome and inflammatory bowel diseases. Orv Hetil. 2005;146(17):797-802.Niec A. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol. 1998;93(11):2184-2190. doi: 10.1111/j.1572-0241. 1998.00531.x.Olen O, Neuman A, Koopmann B, et al. Allergy-related diseases and recurrent abdominal pain during childhood - a birth cohort study. Aliment Pharmacol Ther. 2014;40(11-12):1349-1358. doi: 10.1111/apt.12965.Ozol D, Uz E, Bozalan R, et al. Relationship between asthma and irritable bowel syndrome: role of food allergy. J Asthma. 2006;43(10):773-775. doi: 10.1080/02770900601031789.Panicker R, Arifhodzic N, Al Ahmad M, Ali SA. Association and symptom characteristics of irritable bowel syndrome among bronchial asthma patients in Kuwait. Ann Thorac Med. 2010;5(1):37-42. doi: 10.4103/1817-1737.58958.Powell N, Huntley B, Beech T, et al. Increased prevalence of gastrointestinal symptoms in patients with allergic disease. Postgrad Med J. 2007;83(977):182-186. doi: 10.1136/pgmj.2006.049585.Petitpierre M, Gumowski P, Girard JP. Irritable bowel syndrome and hypersensitivity to food. Ann Allergy. 1985;54(6):538-540.el Rafei A, Peters SM, Harris N, Bellanti JA. Diagnostic value of IgG4 measurements in patients with food allergy. Ann Allergy. 1989;62(2):94-99.Santos J, Bayarri C, Saperas E, et al. Characterisation of immune mediator release during the immediate response to segmental mucosal challenge in the jejunum of patients with food allergy. Gut. 1999;45(4):553-558. doi: 10.1136/gut.45.4.553.Savage JH, Courneya JP, Sterba PM, et al. Kinetics of mast cell, basophil, and oral food challenge responses in omalizumab-treated adults with peanut allergy. J Allergy Clin Immunol. 2012;130(5):1123-1129 e1122. doi: 10.1016/j.jaci.2012.05.039.Simonato B, De Lazzari F, Pasini G, et al. IgE binding to soluble and insoluble wheat flour proteins in atopic and non-atopic patients suffering from gastrointestinal symptoms after wheat ingestion. Clin Exp Allergy. 2001;31(11):1771-1778. doi: 10.1046/j.1365-2222.2001.01200.x.Soares RLS, Figueiredo HN, Maneschy CP, et al. Correlation between symptoms of the irritable bowel syndrome and the response to the food extract skin prick test. Braz J Med Biol Res. 2004;37(5):659-662. doi: 10.1590/s0100-879x2004000500005.Shanahan F, Whorwell PJ. IgG-mediated food intolerance in irritable bowel syndrome: a real phenomenon or an epiphenomenom? Am J Gastroenterol. 2005;100(7): 1558-9. doi: 10.1111/j.1572-0241.2005.50009.x.Tobin MC, Moparty B, Farhadi A, et al. Atopic irritable bowel syndrome: a novel subgroup of irritable bowel syndrome with allergic manifestations. Ann Allergy Asthma Immunol. 2008;100(1):49-53. doi: 10.1016/s1081-1206(10)60404-8.Uz E, Turkay C, Aytac S, Bavbek N. Risk factors for irritable bowel syndrome in Turkish population: role of food allergy. J Clin Gastroenterol. 2007;41(4):380-3. doi: 10.1097/01.mcg.0000225589.70706.24.White AM, Stevens WH, Upton AR, et al. Airway responsiveness to inhaled methacholine in patients with irritable bowel syndrome. Gastroenterology. 1991;100(1):68-74. doi: 10.1016/0016-5085(91)90584-8.Zar S, Mincher L, Benson MJ, Kumar D. Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome. Scand J Gastroenterol. 2005;40(7):800-807. doi: 10.1080/00365520510015593.Zuo XL, Li YQ, Li WJ, et al. Alterations of food antigen-specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia. Clin Exp Allergy. 2007;37(6): 823-830. doi: 10.1111/j.1365-2222.2007.02727.x.