Analysis of Clinical Characteristics of Refractory Food Protein-Induced Allergic Proctocolitis

TL;DR

This study finds that children with late-onset refractory food allergies face more growth issues and need more steroids than those with early-onset cases.

Contribution

The study identifies distinct clinical differences between early- and non-early-onset refractory FPIAP cases.

Findings

Non-early-onset FPIAP cases had higher rates of growth retardation and corticosteroid use.

Early-onset FPIAP patients had better hemoglobin levels and less need for corticosteroids.

Many refractory FPIAP patients developed long-term dietary intolerances to common foods.

Abstract

What are the main findings?
Refractory food protein-induced allergic proctocolitis (FPIAP) is associated with prolonged symptoms, growth retardation, and dietary intolerance.Non-early-onset FPIAP cases showed significantly more growth issues, lower hemoglobin levels, and higher corticosteroid use than early-onset cases.

Refractory food protein-induced allergic proctocolitis (FPIAP) is associated with prolonged symptoms, growth retardation, and dietary intolerance.

Non-early-onset FPIAP cases showed significantly more growth issues, lower hemoglobin levels, and higher corticosteroid use than early-onset cases.

What is the implication of the main finding?
Early identification of FPIAP onset may help reduce the risk of growth delays and the need for corticosteroids.Individualized treatment strategies are needed to improve long-term outcomes and food tolerance in children with refractory FPIAP.

Early identification of FPIAP onset may help reduce the risk of growth delays and the need for corticosteroids.

Individualized treatment strategies are needed to improve long-term outcomes and food tolerance in children with refractory FPIAP.

Background/Objectives: Food protein-induced allergic proctocolitis (FPIAP) is a non-immunoglobulin-E-mediated allergic colitis. Most cases resolve after 1 year of age, but delayed resolution and growth retardation may occur in some refractory cases. We aimed to explore the clinical characteristics, treatment approaches, and outcomes of such pediatric patients. Methods: We retrospectively analyzed 35 patients with refractory FPIAP at our center between January 2015 and January 2025. Patients were categorized into early- and non-early-onset groups according to timing of symptom onset; various clinical data were collected and treatment regimens were monitored. Results: The proportion of patients with growth retardation was significantly higher in the non-early onset group than in the early-onset group (73.3% vs. 35.0%, p = 0.041), whereas hemoglobin levels were higher in the early-onset group (118.95 ± 11.26 g/L vs. 107.93 ± 14.61 g/L, p = 0.017).The proportion of corticosteroid use was significantly lower in the early-onset group (15.0% vs. 60.0%; p = 0.011). During follow-up, among 35 patients, 14 (40%) could not tolerate certain foods, including cow’s milk (100%), eggs (42.9%), and wheat (35.7%). Conclusions: Refractory FPIAP was protracted, with a higher incidence of growth retardation, lower hemoglobin levels, and higher corticosteroid use in the non-early onset group. The optimal treatment approach should be explored.

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