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Characteristics and Prognosis of Allergic Proctocolitis in Infants
Aysenur Kaya1, Muge Toyran, Ersoy Civelek
1*Department of Pediatric Allergy and Immunology †Department of Pediatric Gastroenterology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara ‡Department of Pediatric Allergy and Immunology, Mugla Sıtkı Kocman University, Mugla, Turkey.
Insights
Allergic proctocolitis (AP) in infants is often triggered by milk. While most infants develop tolerance within a year, some may experience prolonged symptoms, necessitating extended follow-up.
Area of Science:
- Pediatric Allergy
- Gastroenterology
- Immunology
Background:
- Allergic proctocolitis (AP) presents with mucoid, frothy, and bloody stools in healthy infants.
- Accurate diagnosis is crucial to differentiate AP from other causes of infant rectal bleeding.
Purpose of the Study:
- To characterize infants diagnosed with AP using a gold-standard food challenge.
- To provide clinicians with insights into typical AP presentation, management, and prognosis.
Main Methods:
- Data collected from infants diagnosed with AP in allergy and gastroenterology clinics.
- Exclusion of other causes of bloody diarrhea; diagnostic skin prick and atopy patch tests performed.
- Endoscopic evaluation for persistent cases unresponsive to dietary changes (maternal diet, amino acid-based formula).
Main Results:
- Sixty infants diagnosed with AP, with onset typically around 1.7 months.
- Milk was the primary allergen in all cases; multiple food allergies noted in some.
- Tolerance acquired by age 1 (53.3%), age 2 (25%), age 3 (5%), and age 4 (1.7%).
Conclusions:
- Milk is the universal trigger for allergic proctocolitis.
- Resolution typically occurs within one year, but symptoms can persist longer.
- Extended follow-up is recommended for infants with AP.
Objectives:
The dietary protein proctocolitis, also known as allergic proctocolitis (AP), is characterized by the presence of mucoid, frothy, and bloody stools in an otherwise healthy infant. The aim of this study was to describe a group of children with AP, diagnosed according to the criterion-standard method, food challenge to provide clinicians with more information on typical presentation, and an overview on nutritional management strategies and prognosis.
Methods:
We collected data on infants with AP in our allergy and gastroenterology outpatient clinics. Any other conditions that may cause bloody diarrhea were ruled out. Skin prick tests and atopy patch tests were performed for diagnosis, and patients were studied for resolution. To the patients whose rectal bleeding did not recover with oligoantigenic maternal diet in addition to amino acid-based formula, endoscopic evaluation was performed to confirm the diagnosis and to exclude other reasons of rectal bleeding.
Results:
Sixty patients were diagnosed as having AP. The age of onset was 1.7 ± 1.32 months. All of the patients were triggered by milk, 6.6% with milk and egg, 3.3% with milk and chicken, 1.7% with milk and wheat, 1.7% with milk and potato, and 3.3% had multiple food allergy. 53.3% (n = 32) acquired tolerance by age 1, 25.0% (n = 15) by 2 years, 5% (n = 3) by 3, and 1.7% (n = 1) by 4 years.
Conclusions:
Milk was a triggering factor for all of the patients. Resolution of AP is usually within 1 year but symptoms of some patients may continue even longer. An extension of the follow-up period is required according to our study.
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