Food Protein-Induced Allergic Proctocolitis (FPIAP)

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Food protein-induced allergic proctocolitis (FPIAP) is a type of delayed inflammatory non-IgE mediated gut food allergy. Symptoms usually start at one to four weeks of age and range from having blood, which is sometimes seen with mucous in bowel movements, to blood stained loose stools or diarrhoea. Infants with FPIAP are usually otherwise healthy and growing well. FPIAP mostly occurs in breastfed infants, but can also occur once cow’s milk or soy based formula is commenced. The main triggers are cow’s milk or soy.

Diagnosis of FPIAP

Allergy tests (skin tests or blood tests for Immunoglobulin E [IgE] antibodies) are negative for infants with FPIAP and therefore not useful.

Diagnosis is based on:

Management of FPIAP

If breastfeeding:

If an infant is formula fed:

Resolution of FPIAP

Resolution of FPIAP usually occurs in 50% of infants by the age of six months, and 95% of infants by the age of nine months.

It is generally recommended to reintroduce the offending food/s to the mother’s or infant’s diet after it has been eliminated for six months or at 12 months of age.

For infants who have more severe symptoms, such as blood stained diarrhoea, the offending food/s may be gradually introduced under the supervision of a dietitian.

References

Caubet, J. C., Szajewska, H., Shamir, R. & Nowak-Wegrzyn, A., (2017). Non-IgE-mediated gastrointestinal food allergies in children. Pediatr Allergy Immunol, 28, 6-17. DOI: 10.1111/pai.12659

Venter, C., Brown, T., Meyer, R., Walsh, J., Shah, N., Nowak-Wegrzyn, A., Chen, T. X., Fleischer, D. M., Heine, R. G., Levin, M., Vieira, M. C. & Fox, A. T., (2017). Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy, 7, 26. DOI: 10.1186/s13601-017-0162-y

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