TY - JOUR
T1 - Prospective Assessment of Pediatrician-Diagnosed Food Protein–Induced Allergic Proctocolitis by Gross or Occult Blood
AU - Martin, Victoria M.
AU - Virkud, Yamini V.
AU - Seay, Hannah
AU - Hickey, Alanna
AU - Ndahayo, Renata
AU - Rosow, Rachael
AU - Southwick, Caroline
AU - Elkort, Michael
AU - Gupta, Brinda
AU - Kramer, Eileen
AU - Pronchick, Tetiana
AU - Reuter, Susan
AU - Keet, Corinne
AU - Su, Kuan Wen
AU - Shreffler, Wayne G.
AU - Yuan, Qian
N1 - Funding Information:
Funding for this study was provided by the Gerber Foundation (grant no. 1685-3680 ), the Demarest Lloyd Jr Foundation (grant no. 230465 ), and the Food Allergy Science Initiative (grant no. 229711 ). Y.V.V. was supported by a grant from the National Institute of Allergy and Infectious Diseases of the US National Institutes of Health (grant no. K23AI130408 ). This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center ( National Center for Advancing Translational Sciences, National Institutes of Health Award no. UL 1TR002541 ) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.
Funding Information:
Funding for this study was provided by the Gerber Foundation (grant no. 1685-3680), the Demarest Lloyd Jr Foundation (grant no. 230465), and the Food Allergy Science Initiative (grant no. 229711). Y.V.V. was supported by a grant from the National Institute of Allergy and Infectious Diseases of the US National Institutes of Health (grant no. K23AI130408). This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award no. UL 1TR002541) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.We are grateful for the tremendous support from the entire study site staff and physicians of Pediatrics at Newton Wellesley and we extend a special thank you to all the participating GMAP study families.
Publisher Copyright:
© 2020
PY - 2020/5
Y1 - 2020/5
N2 - Background: Food protein–induced allergic proctocolitis (FPIAP) is an early and common manifestation of food allergy, yet its epidemiology and relationship to other allergic diseases remain unclear. Objective: To prospectively define the incidence of FPIAP as it is being diagnosed clinically in the community and to identify factors associated with its development. Methods: A total of 1003 of 1162 eligible serial healthy newborn infants recruited from a single suburban pediatrics practice were followed prospectively for the diagnosis of FPIAP. Investigators reviewed each case to confirm prespecified inclusion criteria, including documented gross or occult blood in the stool. Results: A total of 903 infants were analyzed (46% females, 89% term, 32% caesarian-section, 9% neonatal antibiotics); 153 cases met inclusion criteria, a cumulative incidence of 17%, while 63 (7%) had gross blood. Infants initially fed both breast milk and formula were 61% less likely to develop FPIAP compared with those exclusively formula-fed (hazard ratio, 0.39; P = .005). Breast milk and formula at any point during the first 4 months were also associated with lower risk compared with exclusive formula or exclusive breast milk (hazard ratio, 0.44; P = .005; hazard ratio, 0.62; P = .0497). Eczema (odds ratio, 1.5; 95% confidence interval, 1.1- 2.2; P = .02) or a first-degree relative with food allergies (odds ratio, 1.9; 95% confidence interval, 1.2-2.8; P = .005) were among risk factors for FPIAP development. Conclusions: The prospectively defined incidence of FPIAP when diagnosed clinically by community pediatricians without challenge is markedly higher than published estimates. Combination feeding of formula and breast milk is associated with the lowest rate of FPIAP in this population.
AB - Background: Food protein–induced allergic proctocolitis (FPIAP) is an early and common manifestation of food allergy, yet its epidemiology and relationship to other allergic diseases remain unclear. Objective: To prospectively define the incidence of FPIAP as it is being diagnosed clinically in the community and to identify factors associated with its development. Methods: A total of 1003 of 1162 eligible serial healthy newborn infants recruited from a single suburban pediatrics practice were followed prospectively for the diagnosis of FPIAP. Investigators reviewed each case to confirm prespecified inclusion criteria, including documented gross or occult blood in the stool. Results: A total of 903 infants were analyzed (46% females, 89% term, 32% caesarian-section, 9% neonatal antibiotics); 153 cases met inclusion criteria, a cumulative incidence of 17%, while 63 (7%) had gross blood. Infants initially fed both breast milk and formula were 61% less likely to develop FPIAP compared with those exclusively formula-fed (hazard ratio, 0.39; P = .005). Breast milk and formula at any point during the first 4 months were also associated with lower risk compared with exclusive formula or exclusive breast milk (hazard ratio, 0.44; P = .005; hazard ratio, 0.62; P = .0497). Eczema (odds ratio, 1.5; 95% confidence interval, 1.1- 2.2; P = .02) or a first-degree relative with food allergies (odds ratio, 1.9; 95% confidence interval, 1.2-2.8; P = .005) were among risk factors for FPIAP development. Conclusions: The prospectively defined incidence of FPIAP when diagnosed clinically by community pediatricians without challenge is markedly higher than published estimates. Combination feeding of formula and breast milk is associated with the lowest rate of FPIAP in this population.
KW - Cow's milk protein allergy
KW - Food protein–induced allergic proctocolitis
KW - Non–IgE-mediated milk allergy
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U2 - 10.1016/j.jaip.2019.12.029
DO - 10.1016/j.jaip.2019.12.029
M3 - Article
C2 - 31917366
AN - SCOPUS:85078427737
SN - 2213-2198
VL - 8
SP - 1692-1699.e1
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 5
ER -