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Kim and Hwang: The Characteristics and Diagnostic Methods of Food Protein Induced Proctocolitis
Review Article
Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2011; 14(Suppl 1): S47-S54.

Published online: 31 December 2011

DOI: https://doi.org/10.5223/kjpgn.2011.14.Suppl1.S47

The Characteristics and Diagnostic Methods of Food Protein Induced Proctocolitis

Ae Suk Kim, M.D., Jin-Bok Hwang, M.D.*

Department of Pediatrics, Dongguk University College of Medicine, Gyeongju, Korea.

*Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Corresponding author (pedgi@kmu.ac.kr)

Received 7 December 2011       Revised 20 December 2011       Accepted 22 December 2011

Copyright © 2011 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition

Abstract

Food protein induced proctocolitis (FPIPC) is a non-IgE mediated food allergy. FPIPC occurs exclusively among breast-fed infants within the first months of life. FPIPC is often diagnosed clinically in normal-conditioned infants with rectal bleeding. But FPIPC among infancy with rectal bleeding is less general than conceived. The endoscopic findings reveal an edematous and erythematous mucosa with superficial erosions or ulcerations, bleeding and lymphoid nodular hyperplasia. The prominent eosinophilic infiltrates in the rectosigmoid mucosa are important for the histopathologic diagnosis of FPIPC. However, in explaining eosinophilic infiltration within the lamina propria of the mucosa, it is necessary to differentiate whether it is a part of normal findings or occurs due to inflammatory reactions. Oral food challenge and elimination test is performed to identify the same clinical reaction as the symptom of FPIPC by the administration of a specific type of food to infants. The most common causal food is cow's milk. Thus oral food challenge and elimination test can be the effective way of confirming FPIPC, reducing the possibility of misdiagnosis. The purpose of this report is to identify the characteristics of FPIPC, to introduce its diagnostic methods, and to suggest the future direction of research.

Keywords: Food protein induced proctocolitis, Breast-fed infants, Rectal bleeding, Food challenge

Figures and Tables

Fig. 1
Typical endoscopic findings in dietary protein induced proctocolitis, (A) nodular hyperplasia with multiple erosions resembling goose pimply appearance. (B) These findings are prominent in endoscopic deflated state4).
kjpgn-14-S47-g001
Table 1
Classification of Gastrointestinal Hypersensitivities to Food and Other Dietary Products1)
kjpgn-14-S47-i001

References

1. Sampson HA, Anderson JA. Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr. 2000. 30:Suppl. S87–S94.
2. Kumar D, Repucci A, Wyatt-Ashmead J, Chelimsky G. Allergic colitis presenting in the first day of life: report of three cases. J Pediatr Gastroenterol Nutr. 2000. 31:195–197.
3. Faber MR, Rieu P, Semmekrot BA, Van Krieken JH, Tolboom JJ, Draaisma JM. Allergic colitis presenting within the first hours of premature life. Acta Paediatr. 2005. 94:1514–1515.
4. Choi SY, Park MH, Choi WJ, Kang U, Oh HK, Kam S, et al. Clinical features and the natural history of dietary protein induced proctocolitis: a study on the elimination of offending foods from the maternal diet. Korean J Pediatr Gastroenterol Nutr. 2005. 8:21–30.
5. Ohtsuka Y, Shimizu T, Shoji H, Kudo T, Fujii T, Wada M, et al. Neonatal transient eosinophilic colitis causes lower gastrointestinal bleeding in early infancy. J Pediatr Gastroenterol Nutr. 2007. 44:501–505.
6. Xanthakos SA, Schwimmer JB, Melin-Aldana H, Rothenberg ME, Witte DP, Cohen MB. Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study. J Pediatr Gastroenterol Nutr. 2005. 41:16–22.
7. Kim JB, Kim KM, Kim KS, Pi SY, Park YS. A clinical and histological study of allergic colitis in infant. J Korean Pediatr Soc. 1998. 41:521–528.
8. Hwang JB, Choi SY, Kwon TC, Oh HK, Kam S. Clinical observation of gastrointestinal cow milk allergy in children according to a new classification. Korean J Pediatr Gastroenterol Nutr. 2004. 7:40–47.
9. Maloney J, Nowak-Wegrzyn A. Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cows milk allergy. Pediatr Allergy Immunol. 2007. 18:360–367.
10. Feiterna-Sperling C, Rammes S, Kewitz G, Versmold H, Niggemann B. A case of cows milk allergy in the neonatal period--evidence for intrauterine sensitization? Pediatr Allergy Immunol. 1997. 8:153–155.
11. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010. 125:2 Suppl 2. S116–S125.
12. Bone J, Claver A, Guallar I, Plaza AM. Allergic proctocolitis, food-induced enterocolitis: immune mechanisms, diagnosis and treatment. Allergol Immunopathol (Madr). 2009. 37:36–42.
13. Husby S. Food allergy as seen by a paediatric gastroenterologist. J Pediatr Gastroenterol Nutr. 2008. 47:Suppl 2. S49–S52.
14. Lake AM, Whitington PF, Hamilton SR. Dietary protein-induced colitis in breast-fed infants. J Pediatr. 1982. 101:906–910.
15. Prioult G, Nagler-Anderson C. Mucosal immunity and allergic responses: lack of regulation and/or lack of microbial stimulation? Immunol Rev. 2005. 206:204–218.
16. Catlett JB. Ulcerative colitis in an allergic person: case report. Va Med. 1988. 115:434–435.
17. Glassman MS, Newman LJ, Berezin S, Gryboski JD. Cow's milk protein sensitivity during infancy in patients with inflammatory bowel disease. Am J Gastroenterol. 1990. 85:838–840.
18. Sampson HA, Sicherer SH, Birnbaum AH. American Gastroenterological Association. AGA technical review on the evaluation of food allergy in gastrointestinal disorders. Gastroenterology. 2001. 120:1026–1040.
19. Song JY, Kang YN, Kim JR, Hwang JB. Clinical significance of food-specific IgE antibody tests in food protein-induced proctocolitis. Korean J Pediatr Gastroenterol Nutr. 2008. 11:36–41.
20. Arvola T, Ruuska T, Keranen J, Hyoty H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbiological examination. Pediatrics. 2006. 117:e760–e768.
21. Cannioto Z, Berti I, Martelossi S, Bruno I, Giurici N, Crovella S, et al. IBD and IBD mimicking enterocolitis in children younger than 2 years of age. Eur J Pediatr. 2009. 168:149–155.
22. Odze RD, Wershil BK, Leichtner AM, Antonioli DA. Allergic colitis in infants. J Pediatr. 1995. 126:163–170.
23. Machida HM, Catto Smith AG, Gall DG, Trevenen C, Scott RB. Allergic colitis in infancy: clinical and pathologic aspects. J Pediatr Gastroenterol Nutr. 1994. 19:22–26.
24. Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S. Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis. J Korean Med Sci. 2007. 22:213–217.
25. DeBrosse CW, Case JW, Putnam PE, Collins MH, Rothenberg ME. Quantity and distribution of eosinophils in the gastrointestinal tract of children. Pediatr Dev Pathol. 2006. 9:210–218.
26. Manoura A, Hatzidaki E, Korakaki E, Mitsaki M, Valari V, Giannakopoulou C. Eosinophilia in sick neonates. Haematologia (Budap). 2002. 32:31–37.
27. Patel L, Garvey B, Arnon S, Roberts IA. Eosinophilia in newborn infants. Acta Paediatr. 1994. 83:797–801.
28. Yen JM, Lin CH, Yang MM, Hou ST, Lin AH, Lin YJ. Eosinophilia in very low birth weight infants. Pediatr Neonatol. 2010. 51:116–123.
29. Dreger LC, Kozyrskyj AL, HayGlass KT, Becker AB, MacNeil BJ. Lower cortisol levels in children with asthma exposed to recurrent maternal distress from birth. J Allergy Clin Immunol. 2010. 125:116–122.
30. Hwang JB, Song JY, Kang YN, Kim SP, Suh SI, Kam S, et al. The significance of gastric juice analysis for a positive challenge by a standard oral challenge test in typical Cow's milk protein-induced enterocolitis. J Korean Med Sci. 2008. 23:251–255.
31. Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. 2009. 94:425–428.
32. Jang HJ, Song JH, Kang YN, Kim AS, Hwang JB. Is allergic colitis the cause of small and fresh bloody stool in a newborn?: a pilot study of a university hospital. 2010. In : Program and Abstracts, the 61th Annual Fall Meeting of The Korean Pediatrics Society; 2010 Oct 22-23; Seoul. The Pediatric Society.
33. Restani P, Gaiaschi A, Plebani A, Beretta B, Velona T, Cavagni G, et al. Evaluation of the presence of bovine proteins in human milk as a possible cause of allergic symptoms in breast-fed children. Ann Allergy Asthma Immunol. 2000. 84:353–360.
34. Weiner HL. Oral tolerance: immune mechanisms and the generation of Th3-type TGF-beta-secreting regulatory cells. Microbes Infect. 2001. 3:947–954.
35. Laitinen K, Arvola T, Moilanen E, Lampi AM, Ruuska T, Isolauri E. Characterization of breast milk received by infants with gross blood in stools. Biol Neonate. 2005. 87:66–72.
36. Ravelli A, Villanacci V, Chiappa S, Bolognini S, Manenti S, Fuoti M. Dietary protein-induced proctocolitis in childhood. Am J Gastroenterol. 2008. 103:2605–2612.
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