Prognosis and prognostic factors in patients with food protein-induced allergic proctocolitis: A retrospective evaluation

Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated disease that manifests as blood and mucus in the stool in a healthy infant during the first year of life. Its frequency is unknown. Furthermore, there is no evidence in the literature on the development of allergy disease throughout disease follow-up. Our study aims to examine the clinical findings and course of FPIAP to provide information about the risk factors affecting the development of tolerance and new allergic diseases that may develop. In this study, FPIAP patients who were evaluated in Bursa Uludag University Medical Faculty Pediatric Allergy Clinic between June 2015 and June 2020 were retrospectively analyzed. Demographic, clinical characteristics, and laboratory results of the patients were recorded in the standard questionnaire. Multivariate logistic regression analysis was used to determine risk factors for delayed tolerance and for the development of another allergic disease in the follow-up. A total of 91 children (female/male:46/45) were included. The mean age of symptom onset was 2.11±1.55 months. The median age at diagnosis was 4 (0-10) months, and the median age of tolerance was 14 (8:20) months. Ten (11%) patients had blood in stool after rotavirus vaccination. The most common trigger food was cow's milk. Family history of allergic disease was 59.3%. Complaints were 100% blood in stool, 84.6% mucous in stool, 41.8% diarrhea, colic 13.2%, vomiting 13.2%. At diagnosis 77 (84.6%) of the cases were breastfed. At the time of diagnosis, 77 (84.6%) cases had been breastfed. Laboratory results were Sp IgE positivity 11(12.1%), SPT 11(12.1%), elevated total IgE 24 (27.6%), eosinophilia(≥400/Ul) 48 (55%). Another allergic disease was present in 29 (31.9%) of the patients at the time of diagnosis, and also it developed in 52 (57.1%) of the patients during follow-up. Doctor-diagnosed wheezing, atopic dermatitis, allergic rhinitis, urticaria, and food allergies, respectively 10 (19.3%), 26 (25.2%), 9 (17.3%), 5 (5.5%), and 16 (17.6%) were observed. As a result, late tolerance is associated with cesarean delivery, prematurity, and being the first child in the family in BIPAP. Furthermore, cesarean delivery, elevated total IgE, and having another allergic disease at the time of diagnosis were risk factors for delayed tolerance. Tolerance may be delayed in patients with BIPAP who complain of bloody stool after rotavirus vaccination. Eosinophilia is a remarkable parameter in susceptibility to allergic diseases that will develop during follow-up in BPIAP cases.