Abstract
BackgroundAllergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. In most cases a maternal cow milk-free diet leads to a prompt resolution of rectal bleeding, while in some patients a multiple food allergy can occur. The aim of this study was to assess whether the atopy patch test (APT) could be helpful to identify this subgroup of patients requiring to discontinue breast-feeding due to polisensitization. Additionally, we assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. amino acid-based formulaMethodsWe have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. The diagnosis was confirmed by endoscopy with biopsies. Skin prick tests and serum specific IgE for common foods, together with APTs for common foods plus breast milk, were performed. After a 1 month therapy of an AAF all patients underwent a follow-up rectosigmoidoscopy.ResultsPrick tests and serum specific IgE were negative. APTs were positive in 100% infants, with a multiple positivity in 50%. Sensitization was found for breast milk in 100%, cow's milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants.ConclusionsThese data suggest that APT might become a useful tool to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism, with the aim to avoid unnecessary maternal dietary restrictions before discontinuing breast-feeding.
Highlights
Allergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation
The aim of our study was to evaluate whether atopy patch test (APT) could detect non-IgE-mediated polisensitization to food proteins carried via breast milk; we assessed the efficacy of acid-based formula (AAF) when multiple food allergy is suspected
APT positivity for foods and breast milk, in our case series of exclusively breast-fed infants with APC, confirms the hypothesis that food proteins can be transferred through lactation and are potentially able to induce an allergic reaction in infants [14,15,16,17,18,19]
Summary
Allergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. We assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. Allergic proctocolitis (APC) is a cause of rectal bleeding in exclusively breast-fed infants aged from 1 to 6 months [1]. It is due, in most cases, to cow’s milk proteins transferred via breast milk [2]. The aim of our study was to evaluate whether APT could detect non-IgE-mediated polisensitization to food proteins carried via breast milk; we assessed the efficacy of AAF when multiple food allergy is suspected
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