Published Online: January 2, 2016
A perplexing presentation of what is currently presumed to be a form of non-IgE mediated food allergy and sometimes described as Multiple Food Protein Intolerance of Infancy (MFPI) has been observed in the Allergy Clinic at the Royal Children’s Hospital, Melbourne, Australia. Infants present with severe irritability and gastrointestinal symptoms which resolve on exclusive feeding with amino-acid formula (AAF) or for breastfed infants, severely restricted maternal exclusion diets. The distinguishing feature of this presentation is the redevelopment of symptoms with the introduction of most solid foods. Reports of this presentation in the current literature are limited.
In this issue of The Journal of Allergy and Clinical Immunology: In Practice, McWilliam and colleagues describe a series of 38 patients that presented to the Department of Allergy at the Royal Children’s Hospital, Melbourne, Australia over a 5 year period (2008-2013). Patients were identified by medical record review and included if they were diagnosed as having MFPI or symptoms including 1) onset in infancy, 2) asymptomatic on amino acid based formula and 3) inability to tolerate complementary solids due to severe diarrhea/vomiting and irritability. Data was collated via medical record review and parent questionnaires.
All patients had more than one symptom at presentation with 75% experiencing 3-4 symptoms. Irritability was the most commonly reported symptom at 79%. Despite extensive specialist allergy dietitian support, 50% of patients were unable to include more than 5 individual foods in the first 12 months. There was no identified pattern of symptom-inducing foods with a wide range of fruits, vegetables, grains and meats reported to cause symptoms. At follow-up, only 12.5% reported complete resolution whilst 81.5 % reported ongoing diarrhea, abdominal pain and/or distension and continued to exclude 1-6 foods.
This series describes an uncommon but complex presentation of what is currently presumed to be a severe form of non-IgE mediated food allergy. Diagnosis can be difficult with allergy testing negative and other diagnostic tests normal. Management of patients is challenging for the allergy team and food introduction extremely difficult and stressful for families. Corroboration of this syndrome in other centers and further studies would be valuable.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.