Original Article
Food protein–induced allergic proctocolitis may have distinct phenotypes

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Abstract

Background

Food protein–induced allergic proctocolitis (FPIAP) is a non–immunoglobulin E (IgE)-mediated food allergy, which presents with bloody mucoid stool in infants. Although IgE-mediated allergy and sensitizations to offending foods have been described in other non–IgE-mediated food allergies, it has not been investigated in FPIAP.

Objective

To investigate IgE-mediated allergy and sensitization to offending foods in FPIAP.

Methods

Patients (n = 204) were retrospectively recruited and grouped as FPIAP (n = 180; FPIAP with or without the symptoms of IgE-mediated food hypersensitivity to offending and nonoffending foods at initial consultation), FPIAP-IgE sensitization to offending foods (n = 17), and FPIAP-transition to IgE-mediated allergy to offending foods (n = 7). The study was performed in accordance with the protocol approved by the local ethical committee of the Hacettepe University.

Results

The median age of onset of symptoms and the development of tolerance was 2 months (interquartile range [IQR], 1.0-3.0) and 12 months (IQR, 10.0-14.0), respectively, and of the patients with skin prick test or serum specific IgE tests (n = 196), 38 (19.4%) had evidence of IgE sensitization to offending foods at the initial consultation or during follow-up; 17 (8.6%) had IgE sensitization, 7 (3.6%) indicated a transition to IgE-mediated allergy to FPIAP-induced foods. The median age of tolerance development of the FPIAP-transition group (19 months, IQR, 18.0-29.0) was significantly later than that of the FPIAP group (11 months, IQR, 10.0-14.0; P < .001) and the FPIAP-IgE sensitization group (11.0 months, IQR, 9.5-12.0; P < .001). Tolerance was observed within the study period in almost all the patients.

Conclusion

Children with FPIAP may have sensitization or develop IgE-mediated allergy over time to offending foods. In addition, IgE sensitization in FPIAP does not have an unfavorable effect on tolerance development; however, the transition to an IgE-mediated phenotype may delay tolerance for a brief time.

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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  • Cited by (0)

    Disclosures: The authors have no conflicts of interest to report.

    Funding: The authors have no funding sources to report.

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