Allergic colitis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Allergic colitis typically develops in early infancy. Allergic colitis is benign, resolving completely in most children without any sequelae. The infants with food protein-induced allergic proctocolitis are usually on exclusive breastfeeding while those with food protein-induced enterocolitis syndrome are often on infant formula. If left untreated, spontaneous resolution may occur in 20% of the children with allergic colitis without elimination of the triggering food. Most infants with allergic colitis will tolerate the offending food by 1 to 3 years of age. | Allergic colitis typically develops in early infancy. Allergic colitis is benign, resolving completely in most children without any sequelae. The infants with [[Food protein-induced allergic proctocolitis (FPIAP)|food protein-induced allergic proctocolitis]] are usually on exclusive breastfeeding while those with [[Food protein-induced enterocolitis syndrome (FPIES)|food protein-induced enterocolitis syndrome]] are often on infant formula. If left untreated, spontaneous resolution may occur in 20% of the children with allergic colitis without elimination of the triggering food. Most infants with allergic colitis will tolerate the offending food by 1 to 3 years of age. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The symptoms of allergic colitis typically develops in early infancy (within the first two or three months of life). The infants with food protein-induced allergic proctocolitis are usually on exclusive breastfeeding while those with food protein-induced enterocolitis syndrome are often on infant formula. Typically, the episodes resolve within 48 to 96 hours following avoidance of the trigger protein. Spontaneous resolution of symptoms may occur in 20% of the children without elimination of the offending protein. Most infants with food protein-induced allergic proctocolitis will be able to tolerate the offending protein by 1 to 3 years of age, while those with food protein-induced enterocolitis syndrome tolerate the offending protein later usually by 2 to 5 years of age.<ref name="pmid21134568">{{cite journal| author=Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA et al.| title=Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. | journal=J Allergy Clin Immunol | year= 2010 | volume= 126 | issue= 6 | pages= 1105-18 | pmid=21134568 | doi=10.1016/j.jaci.2010.10.008 | pmc=4241958 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21134568 }} </ref><ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid22569527">{{cite journal| author=Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S et al.| title=Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. | journal=J Pediatr Gastroenterol Nutr | year= 2012 | volume= 55 | issue= 2 | pages= 221-9 | pmid=22569527 | doi=10.1097/MPG.0b013e31825c9482 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22569527 }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue= | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530 }} </ref> | *The symptoms of allergic colitis typically develops in early infancy (within the first two or three months of life). The infants with [[Food protein-induced allergic proctocolitis (FPIAP)|food protein-induced allergic proctocolitis]] are usually on exclusive breastfeeding while those with [[Food protein-induced enterocolitis syndrome (FPIES)|food protein-induced enterocolitis syndrome]] are often on infant formula. Typically, the episodes resolve within 48 to 96 hours following avoidance of the trigger protein. Spontaneous resolution of symptoms may occur in 20% of the children without elimination of the offending protein. Most infants with [[Food protein-induced allergic proctocolitis (FPIAP)|food protein-induced allergic proctocolitis]] will be able to tolerate the offending protein by 1 to 3 years of age, while those with [[Food protein-induced enterocolitis syndrome (FPIES)|food protein-induced enterocolitis syndrome]] tolerate the offending protein later usually by 2 to 5 years of age.<ref name="pmid21134568">{{cite journal| author=Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA et al.| title=Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. | journal=J Allergy Clin Immunol | year= 2010 | volume= 126 | issue= 6 | pages= 1105-18 | pmid=21134568 | doi=10.1016/j.jaci.2010.10.008 | pmc=4241958 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21134568 }} </ref><ref name="pmid25976434">{{cite journal| author=Nowak-Węgrzyn A| title=Food protein-induced enterocolitis syndrome and allergic proctocolitis. | journal=Allergy Asthma Proc | year= 2015 | volume= 36 | issue= 3 | pages= 172-84 | pmid=25976434 | doi=10.2500/aap.2015.36.3811 | pmc=4405595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25976434 }} </ref><ref name="pmid22569527">{{cite journal| author=Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S et al.| title=Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. | journal=J Pediatr Gastroenterol Nutr | year= 2012 | volume= 55 | issue= 2 | pages= 221-9 | pmid=22569527 | doi=10.1097/MPG.0b013e31825c9482 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22569527 }} </ref><ref name="pmid21762530">{{cite journal| author=Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T et al.| title=Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation. | journal=BMC Gastroenterol | year= 2011 | volume= 11 | issue= | pages= 82 | pmid=21762530 | doi=10.1186/1471-230X-11-82 | pmc=3224143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21762530 }} </ref> | ||
*The natural history of allergic colitis that develops in adolescence or early adulthood especially if due to solid food is poorly characterized with the resolution of symptoms often prolonged.<ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref> | *The natural history of allergic colitis that develops in adolescence or early adulthood especially if due to solid food is poorly characterized with the resolution of symptoms often prolonged.<ref name="pmid21922029">{{cite journal| author=Alfadda AA, Storr MA, Shaffer EA| title=Eosinophilic colitis: epidemiology, clinical features, and current management. | journal=Therap Adv Gastroenterol | year= 2011 | volume= 4 | issue= 5 | pages= 301-9 | pmid=21922029 | doi=10.1177/1756283X10392443 | pmc=3165205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21922029 }} </ref> | ||
===Complications=== | ===Complications=== | ||
Complications of allergic colitis are more common with food protein-induced enterocolitis syndrome (FPIES) than food protein-induced allergic proctocolitis (FPIAP). The complications include:<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid6721558">{{cite journal| author=Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT| title=Food allergy: the major cause of infantile colitis. | journal=Arch Dis Child | year= 1984 | volume= 59 | issue= 4 | pages= 326-9 | pmid=6721558 | doi= | pmc=1628682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6721558 }} </ref> | Complications of allergic colitis are more common with [[food protein-induced enterocolitis syndrome (FPIES)]] than [[food protein-induced allergic proctocolitis (FPIAP)]]. The complications include:<ref name="pmid11264489">{{cite journal| author=Pumberger W, Pomberger G, Geissler W| title=Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. | journal=Postgrad Med J | year= 2001 | volume= 77 | issue= 906 | pages= 252-4 | pmid=11264489 | doi= | pmc=1741985 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11264489 }} </ref><ref name="pmid6721558">{{cite journal| author=Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT| title=Food allergy: the major cause of infantile colitis. | journal=Arch Dis Child | year= 1984 | volume= 59 | issue= 4 | pages= 326-9 | pmid=6721558 | doi= | pmc=1628682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6721558 }} </ref> | ||
*[[Dehydration]] | *[[Dehydration]] | ||
*[[Electrolyte imbalance]] | *[[Electrolyte imbalance]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]
Overview
Allergic colitis typically develops in early infancy. Allergic colitis is benign, resolving completely in most children without any sequelae. The infants with food protein-induced allergic proctocolitis are usually on exclusive breastfeeding while those with food protein-induced enterocolitis syndrome are often on infant formula. If left untreated, spontaneous resolution may occur in 20% of the children with allergic colitis without elimination of the triggering food. Most infants with allergic colitis will tolerate the offending food by 1 to 3 years of age.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of allergic colitis typically develops in early infancy (within the first two or three months of life). The infants with food protein-induced allergic proctocolitis are usually on exclusive breastfeeding while those with food protein-induced enterocolitis syndrome are often on infant formula. Typically, the episodes resolve within 48 to 96 hours following avoidance of the trigger protein. Spontaneous resolution of symptoms may occur in 20% of the children without elimination of the offending protein. Most infants with food protein-induced allergic proctocolitis will be able to tolerate the offending protein by 1 to 3 years of age, while those with food protein-induced enterocolitis syndrome tolerate the offending protein later usually by 2 to 5 years of age.[1][2][3][4]
- The natural history of allergic colitis that develops in adolescence or early adulthood especially if due to solid food is poorly characterized with the resolution of symptoms often prolonged.[5]
Complications
Complications of allergic colitis are more common with food protein-induced enterocolitis syndrome (FPIES) than food protein-induced allergic proctocolitis (FPIAP). The complications include:[6][7]
- Dehydration
- Electrolyte imbalance
- Iron deficiency anemia
- Hypoalbuminemia (from protein-losing enteropathy)
- Failure to thrive (especially in infants with FPIES)
Prognosis
The prognosis of allergic colitis is excellent when it presents in infancy. The disease is benign, self-limiting, and resolves completely, with the child outgrowing the allergy with age. However, the prognosis for allergic colitis that presents in adolescence or adulthood is guarded.[1][3][6]
References
- ↑ 1.0 1.1 Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA; et al. (2010). "Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report". J Allergy Clin Immunol. 126 (6): 1105–18. doi:10.1016/j.jaci.2010.10.008. PMC 4241958. PMID 21134568.
- ↑ Nowak-Węgrzyn A (2015). "Food protein-induced enterocolitis syndrome and allergic proctocolitis". Allergy Asthma Proc. 36 (3): 172–84. doi:10.2500/aap.2015.36.3811. PMC 4405595. PMID 25976434.
- ↑ 3.0 3.1 Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S; et al. (2012). "Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines". J Pediatr Gastroenterol Nutr. 55 (2): 221–9. doi:10.1097/MPG.0b013e31825c9482. PMID 22569527.
- ↑ Lucarelli S, Di Nardo G, Lastrucci G, D'Alfonso Y, Marcheggiano A, Federici T; et al. (2011). "Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation". BMC Gastroenterol. 11: 82. doi:10.1186/1471-230X-11-82. PMC 3224143. PMID 21762530.
- ↑ Alfadda AA, Storr MA, Shaffer EA (2011). "Eosinophilic colitis: epidemiology, clinical features, and current management". Therap Adv Gastroenterol. 4 (5): 301–9. doi:10.1177/1756283X10392443. PMC 3165205. PMID 21922029.
- ↑ 6.0 6.1 Pumberger W, Pomberger G, Geissler W (2001). "Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood". Postgrad Med J. 77 (906): 252–4. PMC 1741985. PMID 11264489.
- ↑ Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT (1984). "Food allergy: the major cause of infantile colitis". Arch Dis Child. 59 (4): 326–9. PMC 1628682. PMID 6721558.