Proctocolitis, food protein induced

Food protein-induced proctitis/proctocolitis, also known as FPIP, is a rare, possibly acute and severe, non-IgE-mediated, intestinal food hypersensitivity.

No sex preference

Aetiopathogenetically, it is based on an (autoimmunological?) intolerance reaction to food proteins. Milk or dairy products (also called mutton milk) are the most common triggers of the symptoms. Less common are soy, cereals, rice, oats or fish or egg products.

The disease mostly affects very young infants (onset in the 1st-3rd month of life). The disease is the most common non-infectious colitis of infants and toddlers.

Diarrhoea and bloody stools often occur after the first contact with the triggering food (note: the disease also occurs in babies fed exclusively on their mother's milk), and after ingestion of food. Lymphonodular hyperplasia with an oedematous swollen mucosa appears. Possibly weight loss, possibly fever. Within the first two years of life there is a >90% development of tolerance.

Possibly blood eosinophilia. No detection of specific IgE antibodies. Reported detection of atypical panca antibodies.

The diagnosis is made through an elimination diet with a non-allergenic special food.

There are clinical analogies to the food protein-induced enterocolitis syndrome.

1. Arik Yilmaz E et al (2017) Characteristics of children with food protein-induced enterocolitis and allergic proctocolitis. Allergy Asthma Proc 38:54-62.
2. González-Delgado P et al. (2016) Clinical and immunological characteristics of a pediatric population with food protein-induced enterocolitis syndrome (FPIES) to fish. Pediatric Allergy Immunol 27:269-275.
3. Järvinen KM et al (2013) Food protein-induced enterocolitis syndrome (FPIES): current management strategies and review of the literature. J Allergy Clin Immunol Pract 1:317-322.
4. Sekerkova A et al (2015) High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food protein-induced proctitis/proctocolitis: Autoimmunity Involvement? J Immunol Res 2015:902863.