Food-Protein Induced Allergic Proctocolitis Is Prospectively Associated With Ige-Mediated Milk And Egg Allergies By Age 3

It remains unclear if food-protein induced allergic proctocolitis (FPIAP) increases the risk of developing IgE-mediated food allergies (FA); it is additionally unclear if FPIAP is part of the atopic march or if the food avoidance necessary to treat FPIAP predisposes to FA by preventing early food introduction. We used a prospective observational cohort of 903 healthy newborn infants to evaluate the rates of FPIAP and FA in young children. FPIAP was diagnosed by the treating physician with diagnosis requiring blood in the stool. FA was determined by independent agreement of two allergist reviewers based on clinical reactivity and documented IgE sensitivity. Of 903 infants analyzed, 153 (16.9%) children were diagnosed with FPIAP and 56 (6.2%) children were diagnosed with FA. Seventeen (11% of FPIAP; 1.9% of whole cohort) children with FPIAP were diagnosed with FA, while 39 (5%) children without FPIAP developed FA (p<0.01). Children with FPIAP were significantly more likely than healthy controls to develop FA to milk (3.9% v. 0.5%, p<0.01) and egg (5.9% v. 2.5%, p<0.05). There were non-significant trends toward higher rates of FA to peanut as well. Infants with FPIAP were significantly more likely to develop IgE-mediated food allergies to milk and egg, with trends toward higher rates of FA to other foods. FPIAP may represent an early step on the atopic march, possibly compounded by subsequent allergen avoidance, to potentially increase the risk of developing some IgE-mediated food allergies.