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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e318250f1a2
Letters to the Editor

Is Delivery by Cesarean Section a Risk Factor for Persistence and Severity in Eosinophilic Gastroenteropathy in Pediatric Patients?

Busoni, Veronica*; Marina, Orsi*; Silvia, Christiansen; Teresa, Davila Maria; Lifschitz, Carlos§

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*Section of Pediatric Gastroenterology, Hepatology and Transplantation

Department of Pathology, Hospital Italiano

Department of Pathology, Children's Hospital “JP. Garrahan”

§Section of Pediatric Gastroenterology, Hepatology and Transplantation, Hospital Italiano, Buenos Aires, Argentina

To the Editor: Early acquired microbiota regulates the immune system and affects health and disease (1–3). Cesarean section (CS)–born babies have a different microflora than those born vaginally (2). An association between CS and atopic disease has been shown (3). Eggesbø et al (4) suggested that CS rather than increasing the overall risk for food allergy increased the risk of persistency of the disease. Fifty percent of children with eosinophilic gastrointestinal disorders (EGID) (5) have atopy and increased total immunoglobulin E and food-specific radioallergosorbent test and/or positive skin tests for foods (6).

We reviewed the records of 12 patients with EGID seen during 11.6 years. All 5 born by CS required corticosteroids for remission and long-term management, and only 1 is presently in remission (Table 1). Only 2 of 7 delivered vaginally (VD) required corticosteroids and 5 remain in remission tolerating a polymeric diet, although 2 still require a hypoallergenic diet but not corticosteroids. Median eosinophil count in CS was 1464 versus 484 cells per microliter in VD (P = 0.07, calculated by Mann-Whitney U test). Four of 5 of CS-born babies had an eosinophil count >600, whereas only 3 of 7 of VD. This limited observation would indicate that CS may be associated with the degree of severity of EGID. New rules put forward in the United Kingdom would make the government pay if a women wants a CS even “for no identifiable reason.” The long-term effect of a CS on the baby's health must be established so that women can make an informed decision before undergoing a CS just for mere personal convenience.

Table 1
Table 1
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REFERENCES

1. an Nimwegen FA, Penders J, Stobberingh EE, et al. Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. J Alllergy Clin Immunol 2011;128:948–55.e1–e3.

2. Gronlund MM, Lehtonen OP, Eerola E, et al. ecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. Pediatr Gastroenterol Nutr 999; 8:9–25.

3. Negele K, Heinrich J, Borte M, et al. ode of delivery and the development of atopic disease during the first 2 years of life. ediatr Allergy Immunol 004; 5:8–54.

4. Eggesbø M, Botten G, Stigum H, et al. esarean delivery and cow milk allergy/intolerance. llergy 005; 0:172–1173.

5. othenberg ME. Eosinophilic gastrointestinal disorders (EGID) J Allergy Clin Immunol 2004;113:11–29.

6. Erwin EA, James HR, Gutekunst HM, et al. erum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. nn Allergy Asthma Immunol 010; 04:96–502.

Copyright 2012 by ESPGHAN and NASPGHAN

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