The effect of formula type on the prognosis of allergic proctocolitis due to cow’s milk allergy

Main Article Content

Mehmet Halil Çeliksoy
Sezin Naiboglu
Erdem Topal
Şefika İlknur Kökçü Karadağ
Ercan Yılmaz
Hamit Bologur

Keywords

allergic proctocolitis, cow’s milk allergy, food allergy, tolerance

Abstract

Background: Food protein-induced allergic proctocolitis is a nonimmunoglobulin E-mediated, self-limited food allergy of the rectum and the colon. Cow’s milk protein is the most common allergen responsible for the disease.


Objective: This study aimed to investigate the roles of different types of formulas in building early tolerance to food protein-induced allergic proctocolitis in infants.


Methods: The medical records of 45 pediatric patients diagnosed with proctocolitis due to cow’s milk allergy between August 2021 and August 2023 and whose disease progression was followed in three tertiary care centers were reviewed retrospectively.


Results: The study included 45 patients who were diagnosed with proctocolitis due to cow’s milk allergy (24 males, 21 females; median age: 4 months). Among them, 24 patients were fed an amino acid-based formula, and 21 (46.7%) patients were fed an extensively hydrolyzed formula. The average age of acquisition of cow’s milk tolerance was lower in the group fed with the amino acid-based formula than in the group fed with extensively hydrolyzed formula (P = 0.038). Furthermore, the group fed with amino acid-based formula had a shorter tolerance period than the group fed with the extensively hydrolyzed formula group (P = 0.044).


Conclusion: Compared to an extensively hydrolyzed formula, an amino acid-based formula led to the early development of tolerance in children with allergic proctocolitis induced by cow’s milk.

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References

1 Fiocchi A, Brozek J, Schunemann H, Bahna SL, von BA, Beyer K, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines. Pediatr Allergy Immunol. 2010;21:1–125. 10.1111/j.1399-3038.2010.01068.x

2 Zhang S, Sicherer S, Berin MC, Agyemang A. Pathophysiology of non-IgE-mediated food allergy. Immunotargets Ther. 2021;10:431–46. 10.2147/ITT.S284821

3 Boné J, Claver A, Guallar I, Plaza AM. Allergic proctocolitis, food-induced enterocolitis: immune mechanisms, diagnosis and treatment. Allergol Immunopathol (Madr). 2009;37(1):36–42. 10.1016/s0301-0546(09)70250-2

4 Czerwionka-Szaflarska M, Łoś-Rycharska E, Gawryjołek J. Allergic enteritis in children. Prz Gastroenterol. 2017;12(1):1–5. 10.5114/pg.2017.65677

5 Galip N, Yuruker O, Babayigit A. Characteristics of allergic proctocolitis in early infancy; accuracy of diagnostic tools and factors related to tolerance development. Asian Pac J Allergy Immunol. 2021. 10.12932/AP-160221-1068

6 Soria R, Del Compare M, Sallaberry M, Martín G, Aprigliano G, Hermida V, et al. Efficacy of an extensively hydrolyzed formula with the addition of synbiotics in infants with cow’s milk protein allergy: a real-world evidence study. Front Allergy. 2023;4:1265083. 10.3389/falgy.2023.1265083

7 Mousan G, Kamat D. Cow’s milk protein allergy. Clin Pediatr (Phila). 2016;55(11):1054–63. 10.1177/0009922816664512

8 Stróżyk A, Horvath A, Meyer R, Szajewska H. Efficacy and safety of hydrolyzed formulas for cow’s milk allergy management: A systematic review of randomized controlled trials. Clin Exp Allergy. 2020; 50 (7): 766–79. 10.1111/cea.13669

9 Meyer R, Groetch M, Venter C. When should infants with cow’s milk protein allergy use an amino acid formula? A practical guide. J Allergy Clin Immunol Pract. 2018;6(2): 383–99. 10.1016/j.jaip.2017.09.003

10 Ribes-Koninckx C, Amil-Dias J, Espin B, Molina M, Segarra O, Diaz-Martin JJ. The use of amino acid formulas in pediatric patients with allergy to cow’s milk proteins: Recommendations from a group of experts. Front Pediatr. 2023;11:1110380. 10.3389/fped.2023.1110380

11 Host A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett P, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999;81:80–4. 10.1136/adc.81.1.80

12 de Boissieu D, Dupont C. Time course of allergy to extensively hydrolyzed cow’s milk proteins in infants. J Pediatr. 2000;136:119–20. 10.1016/s0022-3476(00)90063-5

13 Hill DJ, Cameron DJ, Francis DE, Gonzalez-Andaya AM, Hosking CS. Challenge confirmation of late-onset reactions to extensively hydrolyzed formulas in infants with multiple food protein intolerance. J Allergy Clin Immunol. 1995;96:386–94. 10.1016/s0091-6749(95)70058-7

14 Vanderhoof J, Moore N, de Boissieu D. Evaluation of an amino acid-based formula in infants not responding to extensively hydrolyzed protein formula. J Pediatr Gastroenterol Nutr. 2016;63:531–3. 10.1097/MPG.0000000000001374

15 Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, Aalberse R, et al. Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol. 2004;15(4):291–307. 10.1111/j.1399-3038.2004.00127.x

16 Vandenplas Y, Alarcon P, Alliet P, De Greef E, De Ronne N, Hoffman I, et al. Algorithms for managing infant constipation, colic, regurgitation and cow’s milk allergy in formula-fed infants. Acta Paediatr. 2015;104(5):449–57. 10.1111/apa.12962

17 Munblit D, Peroni DG, Boix-Amorós A, Hsu PS, Van’t Land B, Gay MCL, et al. Human milk and allergic diseases: An unsolved puzzle. Nutrients. 2017;9(8):894. 10.3390/nu9080894

18 Arvola T, Ruuska T, Keranen J, Hyoty H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbiological examination. Pediatrics. 2006;117(4):e760–e768. 10.1542/peds.2005-1069

19 Lozinsky AC, Morais MB. Eosinophilic colitis in infants. J Pediatr (Rio J). 2014;90(1):16–21. 10.1016/j.jped.2013.03.024

20 Pumberger W, Pomberger G, Geissler W. Proctocolitis in breast fed infants: A contribution to differential diagnosis of haematochezia in early childhood. Postgrad Med J. 2001;77(906):252–4. 10.1136/pmj.77.906.252

21 Cetinkaya PG, Kahveci M, Karaatmaca B, Esenboga S, Sahiner UM, Sekerel BE, et al. Predictors for late tolerance development in food protein-induced allergic proctocolitis. Allergy Asthma Proc. 2020;41(1):e11–e18. 10.2500/aap.2020.41.190017