Food protein-induced allergic proctocolitis may have distinct phenotypes

Area of Science:

• Pediatric Allergy and Immunology
• Gastroenterology
• Immunology

Background:

• Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated food allergy characterized by bloody, mucoid stools in infants.
• While IgE-mediated allergies and sensitizations are known in other non-IgE conditions, their role in FPIAP remains under-investigated.

Purpose of the Study:

• To investigate the prevalence of IgE-mediated allergy and sensitization to offending foods in infants diagnosed with FPIAP.
• To understand the clinical implications of IgE sensitization and transition to IgE-mediated allergy in FPIAP patients.

Main Methods:

• Retrospective analysis of 204 infants diagnosed with FPIAP.
• Patients were categorized into FPIAP, FPIAP with IgE sensitization to offending foods, and FPIAP with transition to IgE-mediated allergy.
• Skin prick tests and serum specific IgE tests were utilized to assess IgE sensitization.

Main Results:

• Of 196 patients tested, 19.4% showed evidence of IgE sensitization to offending foods.
• 8.6% had IgE sensitization, and 3.6% transitioned to IgE-mediated allergy.
• The transition to IgE-mediated allergy was associated with a significantly later age of tolerance development compared to FPIAP and FPIAP-IgE sensitization groups.

Conclusions:

• Infants with FPIAP can exhibit IgE sensitization or develop IgE-mediated allergy over time.
• IgE sensitization in FPIAP does not appear to negatively impact tolerance development.
• Transitioning to an IgE-mediated phenotype may cause a temporary delay in achieving tolerance in FPIAP patients.