Outcomes of Infants With Severe Refractory Food Protein-induced Allergic Proctocolitis Treated With Mesalamine

Area of Science:

• Pediatric Gastroenterology
• Allergology
• Clinical Pharmacology

Background:

• Food protein-induced allergic proctocolitis (FPIAP) is a significant cause of lower gastrointestinal distress in infants.
• Severe FPIAP cases often persist despite adherence to strict hypoallergenic diets, including elemental formulas.
• Limited therapeutic options exist for refractory FPIAP, necessitating further investigation into effective treatments.

Purpose of the Study:

• To evaluate the efficacy of mesalamine in managing severe FPIAP symptoms unresponsive to elemental formulas.
• To assess the impact of mesalamine on the need for additional pharmacological interventions for associated conditions.
• To determine the effect of mesalamine on long-term tolerance to standard milk-based formulas.

Main Methods:

• Retrospective chart review of infants diagnosed with severe FPIAP.
• Analysis of patients treated with mesalamine (40-60 mg/kg/d for ~100 days) versus a control group.
• Comparison of symptom improvement, medication requirements, and formula tolerance between groups.

Main Results:

• Mesalamine treatment group demonstrated significantly higher rates of improvement in common FPIAP symptoms.
• Infants receiving mesalamine required less pharmacological treatment for gastroesophageal reflux disease.
• A greater proportion of infants in the mesalamine group successfully transitioned to whole or soy milk post-one year of age.

Conclusions:

• Mesalamine represents a potentially beneficial adjunctive therapy for severe, refractory FPIAP.
• This treatment may reduce the burden of associated symptoms and facilitate earlier reintroduction of standard formulas.
• Further prospective studies are warranted to confirm these findings and establish optimal mesalamine protocols.