Maternal Prenatal Use of Reflux Medication and the Development of Food Protein-Induced Allergic Proctocolitis in Offspring

Ulcerative colitis often develops in the reproductive age women and can cause exacerbation by pregnancy. Mesalazine (5-aminosalicylic acid) is recommended as a safe anti-inflammatory drug during pregnancy. However, maternal mesalazine is transferred to the fetus through the placenta and may cause allergic events. A pregnant woman with severe ulcerative colitis was treated with a dose of mesalazine 4,000 mg/day from early gestation to delivery. Immediately after birth, the preterm neonate vomited bloody contents and discharged massive gross haematochezia. Serum concentrations of mesalazine and its main metabolite were high in the mother and the umbilical cord. Faecal eosinophils and drug-induced lymphocyte stimulation test suggested possibility that sensitisation with mesalazine in utero caused allergic enterocolitis like food protein-induced allergic proctocolitis. Maternal mesalazine has a potential of fetal sensitisation and cause allergic disease.

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Risk Factors Influencing Tolerance and Clinical Features of Food Protein-Induced Allergic Proctocolitis

PEDIATRICS ◽

10.1542/peds.2021-053843bbb ◽

2021 ◽

Vol 148 (Supplement 3) ◽

pp. S37-S37

Author(s):

Price Edwards ◽

Anthony Olive ◽

Carla M. Davis

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Food Protein ◽

Factors Influencing ◽

Allergic Proctocolitis

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Non-IgE-mediated food allergy: Evaluation and management

Paediatrics & Child Health ◽

10.1093/pch/pxaa131 ◽

2021 ◽

Vol 26 (3) ◽

pp. 173-176

Author(s):

Elissa M Abrams ◽

Kyla J Hildebrand ◽

Edmond S Chan

Keyword(s):

Food Allergy ◽

High Rate ◽

Food Protein ◽

Acute Management ◽

Healthy Infants ◽

Ige Mediated ◽

Allergic Proctocolitis ◽

Term Management ◽

Refractory Emesis

Abstract The most common types of non-IgE-mediated food allergy are food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). FPIES presents with delayed refractory emesis, while FPIAP presents with hematochezia in otherwise healthy infants. Acute management of FPIES includes rehydration or ondansetron, or both. No acute management is required for FPIAP. Long-term management of both disorders includes avoidance of the trigger food. The prognosis for both conditions is a high rate of resolution within a few years’ time.

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Newborns with Bloody Stools—At the Crossroad between Efficient Management of Necrotizing Enterocolitis and Antibiotic Stewardship

Antibiotics ◽

10.3390/antibiotics10121467 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1467

Author(s):

Marie Heyne-Pietschmann ◽

Dirk Lehnick ◽

Johannes Spalinger ◽

Franziska Righini-Grunder ◽

Michael Buettcher ◽

...

Keyword(s):

Differential Diagnosis ◽

Antibiotic Treatment ◽

Necrotizing Enterocolitis ◽

Management Strategy ◽

Treatment Guidelines ◽

Food Protein ◽

Antibiotic Exposure ◽

Tertiary Center ◽

Allergic Proctocolitis ◽

Bloody Stools

The onset of bloody stools in neonates often results in antibiotic treatment for suspected necrotizing enterocolitis (NEC). Food protein-induced allergic proctocolitis (FPIAP) is an often-neglected differential diagnosis. We performed a retrospective analysis of antibiotic exposure at our tertiary center from 2011 to 2020 that included three time periods of differing antimicrobial stewardship goals. We compared these data with the conventional treatment guidelines (modified Bell’s criteria). In our cohort of 102 neonates with bloody stools, the length of antibiotic exposure was significantly reduced from a median of 4 to 2 days. The proportion of treated neonates decreased from 100% to 55% without an increase in negative outcomes. There were 434 antibiotic days. Following a management strategy according to modified Bell’s criteria would have led to at least 780 antibiotic days. The delayed initiation of antibiotic treatment was observed in 7 of 102 cases (6.9%). No proven NEC case was missed. Mortality was 3.9%. In conclusion, with FPIAP as a differential diagnosis of NEC, an observational management strategy in neonates with bloody stools that present in a good clinical condition seems to be justified. This may lead to a significant reduction of antibiotic exposure. Further prospective, randomized trials are needed to prove the safety of this observational approach.

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Food protein–induced allergic proctocolitis may have distinct phenotypes

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2020.08.021 ◽

2021 ◽

Vol 126 (1) ◽

pp. 75-82

Author(s):

Pınar Gur Cetinkaya ◽

Melike Ocak ◽

Umit Murat Sahiner ◽

Bulent Enis Sekerel ◽

Ozge Soyer

Keyword(s):

Food Protein ◽

Allergic Proctocolitis

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Increased IgE-Mediated Food Allergy With Food Protein-Induced Allergic Proctocolitis

PEDIATRICS ◽

10.1542/peds.2020-0202 ◽

2020 ◽

Vol 146 (3) ◽

pp. e20200202

Author(s):

Victoria M. Martin ◽

Yamini V. Virkud ◽

Neelam A. Phadke ◽

Kuan-Wen Su ◽

Hannah Seay ◽

...

Keyword(s):

Food Allergy ◽

Food Protein ◽

Ige Mediated ◽

Allergic Proctocolitis

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Non-allergic benign infantile proctocolitis: a neglected nosographic entity

BMJ Case Reports ◽

10.1136/bcr-2021-244918 ◽

2021 ◽

Vol 14 (10) ◽

pp. e244918

Author(s):

Mariannita Gelsomino ◽

Dario Sinatti ◽

Stefano Miceli Sopo

Keyword(s):

Differential Diagnosis ◽

Rectal Bleeding ◽

Well Being ◽

Warning Signs ◽

Clinical Entity ◽

Stool Consistency ◽

Cow Milk ◽

Food Protein ◽

Allergic Proctocolitis ◽

Bloody Stools

The presence of rectal bleeding in the first months of life is very often diagnosed as food protein-induced allergic proctocolitis (FPIAP). The symptoms typically start in infancy, and most cases resolve by age 12 months. Infants with FPIAP usually present bloody stools mixed with mucus, with or without reduced stool consistency. Most affected infants are generally healthy-appearing. We used the story of an infant with rectal bleeding as a reminder that there is also the possibility of a form of benign non-allergic proctocolitis that is not usually included in the differential diagnosis. In the absence of warning signs and in case of infant well-being, it should be the first clinical entity to suspect. Therefore, we suggest we should wait at least 2 months before starting to eliminate cow milk or other foods from the diet.

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Non-IgE Mediated Food Allergy

Current Pediatric Reviews ◽

10.2174/157339631566619103110371 ◽

2020 ◽

Vol 16 (2) ◽

pp. 95-105

Author(s):

Antonella Cianferoni

Keyword(s):

Food Allergy ◽

Eosinophilic Esophagitis ◽

Allergic Diseases ◽

Food Allergies ◽

Food Protein ◽

Ige Mediated ◽

Food Challenges ◽

Allergic Proctocolitis ◽

Eosinophilic Disorders

Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. Non-IgE mediated food allergies are being being investigated.

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