A Case of Transposition of the Great Arteries that Led to the Development of Non-IgE-Mediated Gastrointestinal Food Allergy after a Neonatal Necrotizing Enterocolitis Complication

Abstract

Neonatal necrotizing enterocolitis (NEC) is a serious complication associated with congenital heart disease (CHD). Non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) in neonates and infants manifests as digestive symptoms, including emesis, diarrhea, melena, and abdominal distension, with occasional intestinal perforation and NEC. Previous studies showed the relationship between CHD and non-IgE-GI-FA, which suggests that a decrease in intestinal blood flow can be a risk factor of non-IgE-GI-FA in neonates and infants with CHD. We report the case of a neonate with transposition of the great arteries who developed NEC before an arterial switch operation (ASO) and non-IgE-GI-FA after the operation. The patient presented with bloody stools after the start of formula feeding and was diagnosed with NEC on the basis of abdominal radiography findings. After recovery from NEC, the patient underwent ASO. However, the patient presented with abdominal distension after formula feeding was restarted and was diagnosed with non-IgE-GI-FA on the basis of the findings of eosinophilia and positivity in an allergen-specific lymphocyte stimulation test. This demonstrates that postoperative digestive symptoms impose the possibility of non-IgE-GI-FA in neonates with CHD, especially in those with an NEC complication. Therefore, we infer that if gastrointestinal complications occur in patients with severe CHD, the possibility of non-IgE-GI-FA should be considered.