Original ArticleFood protein–induced allergic proctocolitis may have distinct phenotypes
Introduction
Food protein–induced allergic proctocolitis (FPIAP) presents in the first months of life with bloody, mucoid, frothy stool in otherwise healthy and thriving infants,1 and elimination diet leads to the improvement of symptoms within 72 to 96 hours in most of the infants. Most patients tolerate triggering foods by the age of 1 year.2,3
Food protein–induced allergic proctocolitis is a non–immunoglobulin E (IgE)-mediated food allergy that typically affects the rectosigmoid colon and presents with focal infiltration of eosinophils in the lamina propria, increased intraepithelial CD8-positive T lymphocytes, focal mucosal erythema, and aphthous ulcerations.3, 4, 5 Although FPIAP is a non–IgE-mediated food allergy, evidence of IgE sensitization has been previously reported in a minority of patients with FPIAP.6 The prevalence of IgE sensitization to the offending food and concomitant IgE sensitization and allergy to other foods in FPIAP is still unknown. The transition to IgE-mediated food allergy to offending foods has not been investigated in FPIAP. This is a complementary study of our previous report in which we characterized our patients with FPIAP.7 This study reports our data concerning IgE sensitization and transition to IgE-mediated allergy to FPIAP-triggering foods during follow-up. Thus, this study focuses on the different phenotypes of FPIAP.
Section snippets
Study Population
Infants diagnosed as having FPIAP were retrospectively reviewed, and patients who consulted between January 2015 and December 2018 were included in this study. The infants in the first few months of life with blood and mucus in stool after the ingestion of the suspected food were diagnosed as having FPIAP after the exclusion of other causes of rectal bleeding, resolution of rectal bleeding after the elimination of the offending allergen within 72 hours, and reoccurrence of rectal bleeding after
Results
The characteristics of 204 patients (n = 109, 53.4% of the patients were women) with FPIAP were analyzed. The median age at the onset of symptoms was 2 months (25%-75%; IQR, 1.0-3.0). In 62.7% of the patients (n = 128), the triggering food was only cow's milk. In 36.7% (n = 75), cow's milk was accompanied by other foods, and in only 0.5% (n = 1), the offending allergens were triggers other than cow's milk products. A total of 7 patients were lost to follow-up, and 194 patients (95.0%) tolerated
Discussion
This study reports the transition of non-IgE food hypersensitivity to the IgE-mediated allergy and sensitization to the FPIAP-triggering foods. Among patients who underwent SPT and serum sIgE tests (n = 196), 38 (19.4%) had evidence of IgE sensitization to offending foods, 17 (8.6%) had IgE sensitivity, and 7 (3.6%) shifted to IgE-mediated allergy to FPIAP-triggering foods. The patients who shifted to IgE-mediated allergy to offending foods developed tolerance significantly later compared with
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Disclosures: The authors have no conflicts of interest to report.
Funding: The authors have no funding sources to report.