Recently, Dr. Victoria Martin gave our group an excellent update on cow’s milk protein allergy/food protein-induced allergic proctocolitis (FPIAP).  My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of her slides.

• The nomenclature is not perfect. FPIAP was used for this presentation –though many don’t truly have proctocolitis and others may have involvement in other parts of GI tract
• There is not a good biomarker for FPIAP

• Victoria and her colleagues have a cohort of 1003 children who were enrolled at their 1st well-child visit as part of their Gastrointestinal Microbiome and Allergic Proctocolitis (GMAP) study. These participants are now ~8 years old and will be followed until they are 18 years old

• In the GMAP cohort, 17% were given a diagnosis of FPIAP (mainly by PCPs). This group had increased likelihood of eczema, family hx/o food allergy and sibling with FPIAP.
• The presence of heme-positive stools, vomiting and fussiness are common and usually do not require dietary restrictions unless other symptoms are present (eg. diarrhea, visible blood)

• In the GMAP cohort, the risk for FPIAP was higher if fed formula than breastfeeding. However, exclusive breastfeeding was associated with a higher prevalence than those who received both breastmilk and formula

• A diagnosis of FPIAP was associated with a 2-fold risk of developing an IgE-mediated food allergy. (This indicates that early introduction of food allergens may be beneficial as has been shown with peanut introduction.)

• The microbiome/taxa in FPIAP was unique and present prior to the development of symptoms

• Unique microbiome differences may be identified in FPIAP cohort that precedes and follows FPIAP symptoms
• Allergy testing is generally not helpful in infants less than 6 months of age with FPIAP. RAST testing less than 6 months of age is not sensitive and most FPIAP is not IgE-mediated

• FPIAP may be analogous to eczema of the GI tract

Related blog posts:

• Good Bowel Sound Podcasts: Cow’s Milk Intolerance and Hirschspurng Disease
• ESPGHAN Guidance for Suspected Cow’s Milk Allergy in Infants
• Current Approach for FPIES (2023)
• Allergy Prevention Strategy: Early Exposure Beneficial (Long-term Data for Peanuts)
• Overdiagnosis of Milk Allergy in Infancy and New Consensus Recommendations
• Overdiagnosis of Cow’s Milk Protein Allergy in Infants and Formula Industry Influence
• Best of Allergy Articles 2021 -Cow’s Milk Allergy/Allergic proctocolitis (Part 4)
• Best Allergy Articles 2021 -Cow’s Milk Allergy (Part 3)
• Best Allergy Articles 2021 -Cow’s Milk Allergy (Part 2)
• Best Allergy Articles 2021-Cow’s Milk Allergy