Food protein-induced proctocolitis of infancy
- Alan M Lake, MD
Alan M Lake, MD
- Associate Professor of Pediatrics
- Johns Hopkins University School of Medicine
- Section Editors
- Scott H Sicherer, MD, FAAAAI
Scott H Sicherer, MD, FAAAAI
- Section Editor — Food Allergy
- Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
- B UK Li, MD
B UK Li, MD
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- Medical College of Wisconsin
Food protein-induced proctocolitis (formerly known as allergic or eosinophilic proctocolitis, or "protein intolerance") is a common cause of rectal bleeding in an otherwise healthy young infant, and in most cases resolves by late infancy. It is characterized by inflammation of the distal colon in response to one or more food proteins, through a mechanism that does not involve immunoglobulin E (IgE). Cow's milk and soy protein are common triggers. An association of symptoms to food protein antigens requires demonstration of objective improvement following withdrawal of the suspected food antigen, and in some cases, recurrence following a subsequent oral challenge. This disorder will be discussed in this topic review.
Other disorders of infancy characterized by non-IgE-mediated gastrointestinal inflammatory responses to food are food protein-induced enterocolitis syndrome (FPIES), in which the entire gastrointestinal tract is affected and the clinical manifestations are severe , and food protein-induced enteropathy in which the small bowel is affected. These disorders are discussed separately. (See "Food protein-induced enterocolitis syndrome (FPIES)".)
CLASSIFICATION AND TERMINOLOGY
Immunologic reactions to dietary proteins may be classified as immunoglobulin E (IgE)-mediated, non-IgE-mediated, or mixed (table 1). Guidelines from a panel of experts in allergy and immunology published in 2010 clarified the clinical distinctions and pathophysiologic processes implicated in each of these disorders, and established the classification and terminology used in this topic review .
●IgE-mediated – The classical food allergy (food-induced anaphylaxis) is mediated by Ig-E antibodies to food proteins with mast cell activation, and is also termed immediate hypersensitivity. These reactions are rapid in onset, typically beginning within minutes to two hours from the time of ingestion. Signs and symptoms can involve the skin, respiratory and gastrointestinal tracts, and cardiovascular system, in isolation or combination. This type of reaction is discussed in separate topic reviews. (See "Clinical manifestations of food allergy: An overview" and "Food allergy in children: Prevalence, natural history, and monitoring for resolution".)
●Mixed – Some food allergy disorders can have both IgE- and non-IgE-mediated components. These disorders are typically isolated to the gastrointestinal tract and/or skin. They include:
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- CLASSIFICATION AND TERMINOLOGY
- DIETARY TRIGGERS
- CLINICAL PRESENTATION
- DIFFERENTIAL DIAGNOSIS
- Exclusively breastfed infants
- Formula-supplemented or -fed infants
- Evaluating response
- Management of younger siblings
- SUMMARY AND RECOMMENDATIONS