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Best of Allergy Articles 2021 -Cow’s Milk Allergy/Allergic proctocolitis (Part 4)

January 6, 2022 7:00 am

In Pediatrics, supplement 3 summarizes 76 articles: Synopsis Book: Best Articles Relevant to Pediatric Allergy, Asthma and Immunology

Some of the studies that are most relevant to pediatric GI doctors I am reviewing for this blog over the next/past few days.

A Lemoine et al. Clin Exp Allergy 2021:51(9):1242-1245. doi:10.1111/cea.13896. Rectal bleeding and cow’s milk protein-induced allergic proctocolitis: A prospective study

In this prospective cohort of infants (in France) with food protein-induced allergic proctocolitis (FPIAP) (n=76), all infants had rectal bleeding (RB) which resolved with cow’s milk protein (CMP) elimination. After the initial oral food challenge (OFC) which took place 2 to 8 weeks after resolution of rectal bleeding, OFC was repeated every 2 months.

Key findings:

Only 31% failed the initial OFC
The median age of tolerance, for those with a confirmed FPIAP based on OFC, was 6.8 months, with >75% of the cohort tolerant by 10 months of age

My take:

This study shows that the majority of infants with RB probably do not have FPIAP. In those that do have FPIAP, earlier challenge is reasonable in the majority.
FPIAP is generally mild and self-limited. Diagnosis is hampered by lack of validated criteria.