Dietary Protein-Induced Proctocolitis in Childhood

Abstract

Cow's milk protein-induced proctocolitis presents with overt rectal bleeding in otherwise healthy infants and is characterized by an eosinophilic infiltrate of the left colonic mucosa. Although it is the most common cause of proctocolitis in infancy, dietary protein-induced proctocolitis had hardly ever been reported in childhood so far. We hereby report 16 otherwise healthy children aged 2-14 yr, who presented over a 6-yr period with persistent or recurrent rectal bleeding related to a mild form of left-sided colitis characterized by a prominent eosinophilic infiltration, focal lymphoid follicle hyperplasia, and a prompt clinical and histological response to a cow's milk-free diet. No patient had a history of food-induced proctocolitis during infancy, and most patients did not show an IgE-mediated response to cow's milk protein. Half of the patients did have other gastrointestinal symptoms, but no systemic symptoms were present and other causes of colitis were excluded by appropriate investigation. Tolerance to cow's milk protein developed in half of the patients within a year. Dietary protein-induced proctocolitis is a relatively common cause of overt rectal bleeding in childhood, and its features are remarkably similar to those of dietary protein-induced proctocolitis of infancy.

Non-Celiac Wheat Sensitivity as an Allergic Condition: Personal Experience and Narrative Review

“…Similar histological data were reported in school-age children with rectal bleeding due to allergic procto-colitis ( 48 ). It is also interesting that in 70 of 206 (35 % ) patients with NCWS and CM protein hypersensitivity, we found the presence of lymphoid hyperplasia in the colon mucosa ( 7 ).…”

Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy

“…Ravelli et al reported 16 cases of rectal bleeding that resolved with elimination of cow's milk protein in children aged 2 to 14 years. Endoscopic and histologic findings were additionally consistent with FPIAP [34]. It is not clear, however, whether this is the same clinical entity.…”

Food Protein-Induced Non-Immunoglobulin E-Mediated Allergic Colitis in Infants and Older Children: What Cytokines Are Involved?

“…FPIAP has long been known to be a common cause of rectal bleeding in small infants. Recently, however, a series of 16 children between 2 and 14 years of age was described, with features remarkably similar to those observed in infancy FPIAP, providing evidence that FPIAP also affects older children [7]. In the current study, 7 patients (group 2) with these features were included.…”

“…Recently, a microarray analysis of mucosal biopsy specimens demonstrated that the expression of CCL11 and CXCL13, but not TH1-, TH2-, or TH17-related molecules, was significantly enhanced in these patients [6]. Although the condition is largely considered a disease of small infants, a recent report described FPIAP also in older children (age 2-14 years), with features remarkably similar to those observed in infancy [7]. Of note, an adult form of eosinophilic colitis, which is not related to food allergy and tends to have a less favorable prognosis, has also been described in rare individuals [8].…”

“…Cow's milk is the most frequently implicated food, though there have been reports involving soy, egg, and wheat [7,8,9]. Exclusion of the offending protein from the infant's formula or from the lactating mother's diet is followed by prompt clinical remission, with resolution of gross rectal bleeding within 72-96 h and recurrence of symptoms within 72 h following rechallenge [9].…”