Hello Dr. Olsen. I was wondering if you might be able to shed some light on some bloodwork results for my son.

Curran is 5 years old and has had chronic diarrhea/bowel issues for nearly 4 years now. All stool testing has been negative, including those for celiac. Simply put, he reacts to a wide variety of foodstuffs and we can not seem to find an underlying cause for it.

So far, it has come to light that he has allergies to peanut/treenut and milk and suffers from fructose and sucrose malabsorption (GI says he has a problem with carbohydrates in general and is a "fermentor"). He was scoped both upper and lower last fall and his upper was clear, his lower was incomplete as we missed a step in the clean out process. :oops: He is due to be scoped again this November. The GI has labelled him as having "functional bowel syndrome" and feels that he does have an underlying issue that will show up in time, hence she has kept him as a patient. Just to make things interesting, he is also a refluxer, but now well controlled.

For as long as I can remember, his SED rate has been elevated, sometimes exceptionally high (even when he has been "healthy"), as are his IgE and eosinophils. His IgE is climbing still and now is at 1068 (normal is <240), his eosinophils are at .7 (I believe I was told normal was below .1) and I have been told both these values are significant. He was off all known allergens at the time of testing. All other bloodwork to my knowledge is within normal values and we are currently awaiting results from pancreatic enzyme testing.

My question to you is twofold:

1. Is there anything else that can cause these elevated values other than typical allergy? He has no sign of environmental allergy whatsoever and seems just to react intestinally to foodstuffs.

2. We have been told that if his allergy testing comes back as clear then we investigate "gut allergy" and I was wondering if you can shed some light on what the difference might be between the two? (allergy vs. gut allergy).


Thank you for your time.

Hi,

I have some thoughts, but remember, I am a general pediatrician and I would clearly refer someone with these symptoms to a pediatric gastroenterologist. I would not refer to an adult based specialist.

There are a variety of esoteric diseases that fall into the category of eosinophilic infiltrations of the GI system. Some have high serum eosinophil levels and others don't. I would think that with the high sed rates and the very high eosinophil levels that a specific diagnosis could be made. I would recommend discussing this with the gastroenterologist. If this is not a pediatric specialist, I would seek one out for an evaluation at a pediatric hospital. Perhaps a biopsy of some part of the GI tract is warranted.

Sorry I can't be of more help. In light of the very significant lab findings, the diagnosis of a "functional" disease leaves a bit to be desired, in my opinion.

Good luck, Dr. olson