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Clinical Features and Clinical Course of Food Protein-Induced Allergic Proctocolitis: 10-Year Experience of a
Nur Senocak1, Aysegul Ertugrul2, Serap Ozmen2
1Dr. Sami Ulus Maternity and Children Training and Research Hospital, Department of Pediatrics, University of Health Sciences, Ankara, Turkey.
Insights
Food protein-induced allergic proctocolitis (FPIAP) in infants often presents with bloody stools. Premature birth and formula use can affect symptom onset and tolerance development in FPIAP cases.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Clinical Nutrition
Background:
- Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE mediated gastrointestinal food allergy.
- It is characterized by rectal bleeding in otherwise healthy infants, primarily breastfed.
- Understanding FPIAP's clinical course is crucial for effective management.
Purpose of the Study:
- To investigate the clinical course of FPIAP.
- To identify factors influencing the development of tolerance to food proteins in FPIAP patients.
- To analyze the impact of prematurity, birth history, and formula type on FPIAP.
Main Methods:
- Retrospective analysis of FPIAP patients over a 10-year period.
- Data collected from an Allergy-Immunology outpatient clinic at a tertiary care children's hospital.
- Statistical analysis to determine associations between clinical factors and FPIAP course.
Main Results:
- FPIAP occurred in 0.18% of patients; median onset at 2 months, tolerance at 12 months.
- Neonatal symptoms linked to prematurity and NICU stay (OR 3.75, P=.031; OR 4.72, P=.002).
- Formula use (cow's milk-based) associated with later onset (OR 2.69, P=.016); amino acid formula and diarrhea delayed tolerance (P=.023, P<.001).
Conclusions:
- FPIAP symptoms manifest earlier in premature infants and later in formula-fed infants.
- Amino acid-based formula and diarrhea are associated with delayed tolerance development in FPIAP.
- These findings aid in predicting FPIAP course and guiding therapeutic interventions.
Background:
Food protein-induced allergic proctocolitis (FPIAP) is a food allergy characterized by bloody stools in well-appearing breast-fed infants.
Objective:
To determine the clinical course of FPIAP and the factors affecting the development of tolerance.
Methods:
Over a 10-year period, patients with a diagnosis of FPIAP who were followed at the outpatient Allergy-Immunology clinic in a tertiary care children's hospital in Turkey were retrospectively analyzed.
Results:
The frequency of FPIAP was 0.18% among 64,549 patients. The median age of symptom onset was 2 months (interquartile range, 1.0-3.5 months), and the median age of tolerance development was 12 months (interquartile range, 8.0-17.21 months). The occurrence of symptoms in the neonatal period was associated with a history of premature birth (odds ratio, 3.75; 95% CI, 1.33-10.59; P = .031) and neonatal intensive care unit hospitalization (odds ratio, 4.72; 95% CI, 1.78-12.53; P = .002). Use of a cow's milk-based formula was associated with a higher risk of the onset of symptoms after 1 month (odds ratio, 2.69; 95% CI, 1.19-6.07; P = .016). The use of an amino acid-based formula and the presence of diarrhea at admission were associated with later development of tolerance (P = .023 and P < .001, respectively). An IgE-mediated reaction was observed during oral food challenge testing in 6% of the patients.
Conclusions:
The manifestations of FPIAP appeared earlier in premature infants and later in infants using formula. The use of amino acid-based formula and having had diarrhea were associated with delayed tolerance.
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