Rapid elimination diet for mild hematochezia in the well‐being infant

Abstract

To the Editor, Rectal bleeding presenting as mild hematochezia in an infant younger than 6 months who has no alarm signs and/or symptoms (failure or stunt to thrive, ill-appearing child, abnormal vital signs including fever and hypothermia, perianal disease, abdominal distension, anemia) is typically attributed to Food Protein-Induced Allergic Proctocolitis (FPIAP). 1 In this case, the classical algorithms 1,2 entail a sequential elimination diet.However, there are important doubts as to whether the cause of mild hematochezia in a well-being infant is always, or even only in the most cases, of allergic nature. And, even if the cause is allergic, there are doubts as to whether an elimination diet is still appropriate. We briefly examine the various possible management options and, above all, we propose a new mode of elimination diet, the "Rapid Elimination Diet" (RED, that involves the simultaneous elimination of the seven most suspect foods from the mother's diet for 1 week and then it is not directed at exclusively formula-fed infants), to quickly resolve the issue "allergy yes or no." Three possible alternative managements are proposed in a new algorithm that we propose here (see Figure 1).The available algorithms clearly indicate the actions to take. 1,2 If the hematochezia lasts less than 4 weeks, we could wait, according to Mennini et al., 1 as already suggested. 3 After 4 weeks of waiting, the elimination diet must be started in the attempt to find the triggering food. Cow's milk is first removed, then soy and chicken egg. Barni et al. 2 do not consider an initial phase of waiting and suggest starting the elimination diet immediately. In both algorithms, the infant with mild hematochezia and in good health conditions, after 3 weeks of ineffective elimination diet, has to be directed to a gastroenterological examination with the specific aim of performing a colonoscopy.