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Clinically diagnosed food-protein induced allergic proctocolitis

Published online: January 6, 2020

Food protein-induced allergic proctocolitis (FPIAP) is commonly diagnosed by pediatricians leading to dietary elimination of at least milk protein for most of infancy. Yet, this diagnosis has not been prospectively evaluated in the primary care setting and its relationship to other allergic diseases remains unclear. Because both the underlying disease pathophysiology of FPIAP itself and current management by dietary restriction may increase the risk of IgE-mediated food allergy later in life, prospective characterization is an important objective.

Martin et al. recently reported in The Journal of Allergy and Clinical Immunology: In Practice the primary clinical outcomes from the Gastrointestinal Microbiome and Allergic Proctocolitis (GMAP) Study, a prospective observational 1,000 healthy infant cohort study designed to characterize the diagnosis, management, and epidemiology of FPIAP in the primary care pediatrics setting. Children were followed at all well-child visits from 1 week to 3 years of age, and long-term follow-up in the study is ongoing. All FPIAP cases were reviewed by investigators to confirm prespecified inclusion criteria including blood in the stool, but the initial diagnosis was made clinically by the treating physician (often without oral challenge).

In this prospective observational cohort study of healthy newborn infants, 17% were diagnosed with FPIAP by their pediatrician with occult or gross blood in their stool. Exclusive formula feeding, eczema, and a family history of food allergies were among statistically significant risk factors for FPIAP development, while infants who were fed both breastmilk and formula in the first four months of life were the least likely to develop FPIAP [hazard ratio (HR) = 0.44, compared to exclusive formula; HR=0.62, compared to exclusive breastmilk]. The high rate of clinically diagnosed FPIAP and subsequent dietary elimination across infancy highlight the need for more discerning biomarkers and the observed effect of mixed feeding suggest that interventional studies to evaluate the impact of early cow’s milk exposure may be warranted. Ongoing prospective study of these infants with FPIAP to evaluate their risk of IgE-mediated food allergy later in childhood will also be important.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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