The role of food allergy (FA) in the development of clinical reactions to food in patients with inflammatory bowel disease (IBD) is being studied and remains highly controversial. However, it is obvious that for personalized therapy of this category of patients, it is necessary to consider all possible forms of food hypersensitivity. Objective of the research: to develop a questionnaire to identify latent forms of cow's milk protein allergy (CMPA) in children with IBD and to evaluate the effectiveness of its use. Materials and methods: 376 children were questioned: 176 children with IBD in remission and/or with a low degree of disease activity (1st group); 100 with confirmed CMPA (2nd group); 100 without FA manifestations (3rd group). Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences Inc., USA) version 26.0. Data analysis included standard descriptive and analytical statistics. Results: using a structured questionnaire for collecting anamnesis, it was found that the frequency of allergic reactions to food in the family history of children with IBD and in the group of patients with CMPA did not differ significantly. The introduction of dairy products into complementary foods earlier than at the age of 6 months in IBD patients was noted statistically significantly more often than in children with CMPA and children in the comparison group; the most significant difference was noted in patients with Crohn's disease (CD). In the early history, among children with IBD 83 (47,1%) had skin rashes, 121 (68,7%) regurgitation, 138 (78,4%) colic, 68 (38,6%) constipation. %), blood in stool – 53 (30,1%), mucus (in significant amounts) in stool – 70 (39,7%), loose stool – 77 (43,7%), delayed weight gain was noted in 25 (14,2%) children. At the same time, regurgitation and colic in children with IBD in the first year of life were noted statistically significantly more often than in children with CMPA and children in the comparison group. The frequency of symptoms such as blood and mucus in the stool, diarrhea and delayed weight gain in the first year of life did not statistically significantly differ in children with IBD and in the group of children with CMPA, but was significantly more frequent than in group 3. The median of the indicator according to the results of the questionnaire survey in children with CD was 57 points [52; 62], with ulcerative colitis (UC) – 54 points [50; 57], with PA – 61 points [58; 64], in the 3rd group – 10 points [8; 14]. At a threshold value (cutoff point) of 55 points, the sensitivity and specificity of the method were 79% and 74%, respectively. The area under the ROC curve, corresponding to the relationship between the presence of a subclinical form of allergy and the scores of the questionnaire, was 0,819±0,022 with 95% CI: 0,776–0,862. The resulting model was statistically significant (p<0,001). Conclusion: the questionnaire survey of children with IBD using a questionnaire aimed at identifying latent forms of FA allowed to reveal history peculiarities of children with IBD. The obtained indicators of questionnaire sensitivity and specificity allowed to use it in clinical practice as an additional screening method for detecting latent forms of CMPA in IBD patients with subsequent correction of nutritional support.
Massive hematemesis and melena stool: A case report of unusual manifestation of Cow’s milk protein intolerance