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Characteristics of allergic proctocolitis in early infancy; accuracy of diagnostic tools and factors related to
Nilufer Galip1, Ozel Yuruker2, Arzu Babayigit1
1Department of Pediatrics, Division of Pediatric Allergy and Immunology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus.
Insights
Allergy provocative testing (APT) aids in managing food protein-induced allergic proctocolitis (FPIAP) by guiding elimination diets. Other diagnostic tools like skin prick testing (SPT), specific IgE, and fecal calprotectin are not essential for FPIAP management or predicting tolerance development.
Area of Science:
- Pediatric Gastroenterology
- Allergy and Immunology
- Clinical Nutrition
Background:
- Food protein-induced allergic proctocolitis (FPIAP) is a common cause of lower gastrointestinal symptoms in infants.
- Understanding diagnostic tools and factors influencing tolerance development is crucial for effective FPIAP management.
Purpose of the Study:
- To evaluate the clinical characteristics of FPIAP.
- To assess the utility of diagnostic tools such as allergy provocative testing (APT), skin prick testing (SPT), and fecal calprotectin levels.
- To identify factors associated with tolerance development in infants with FPIAP.
Main Methods:
- Retrospective analysis of 169 infants diagnosed with FPIAP between January 2015 and January 2019.
- Data collection included clinical characteristics, APT, SPT, specific IgE levels, fecal calprotectin, suspected trigger foods, diet, and tolerance status.
- Univariate and multivariate logistic analyses were performed to identify risk factors for delayed tolerance.
Main Results:
- 92% of infants tested positive for at least one food allergen via APT.
- Only 48.2% and 13.3% showed positivity on SPT and specific IgE tests, respectively.
- Univariate analysis identified mucoid diarrhea, family history of allergies, cow's milk sensitivity, and multiple allergen triggers as risk factors for delayed tolerance, but these were not significant in multivariate analysis.
Conclusions:
- Allergy provocative testing (APT) appears valuable for guiding elimination diets in breastfeeding mothers for FPIAP management.
- Skin prick testing (SPT), specific IgE, and fecal calprotectin levels are not deemed necessary for managing FPIAP.
- No evaluated parameters showed a statistically significant relationship with tolerance development in multivariate regression analysis.
Objective:
We aimed to overview clinical characteristics of FPIAP with the results of diagnostic tools like APT, SPT and fecal calprotectin levels and the factors associated with tolerance development.
Methods:
All patients diagnosed FPIAP at the outpatient clinic between January 2015 and January 2019 were enrolled retrospectively. Data about clinical characteristics, APT or SPT results, fecal calprotectin levels, suspected triggering foods, diet and tolerance status were obtained from the hospital database program and analyzed.
Results:
169 infants with F/M ratio 78/91 were enrolled. The mean age of the study population was 3.68 months (1-35 months, mean age 3.68 ± 4.33). APT was performed 137 of the participants and 126 (92%) of them were positive to at least one food allergens, 14 (48.2%) patients had positivity to at least one of the food allergens on SPT. Specific IgE were done in 90 patients and 12 (13.3%) revealed positive results. Two groups of patients developing tolerance before and after 18 months of age were evaluated; mucoid diarrhea, family history allergic diseases, cow's milk sensitivity and multiple allergen triggers were statistically significant risk factors for delayed tolerance according to univariate logistic analysis. However, none of these factors were revealed statistical significance in multivariate logistic analysis.
Conclusions:
Our study revealed that APT may be a useful tool for programming the elimination diet in breastfeeding mothers. SPT, specific IgE and fecal calprotectin are not necessary for FPIAP management. Multivariate regression analysis showed that none of the evaluated parameters had statistically significant relationship with the tolerance development.
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