Food Protein Induced Allergic Proctocolitis: What Do We Know and Where Are We Going?

Abstract Purpose of Review Food protein induced allergic proctocolitis (FPIAP) is a frequently encountered non-IgE-mediated gastrointestinal disorder, affecting both breastfed and formula-fed infants. The natural history of FPIAP typically involves spontaneous resolution, often within the first year of life, even without specific dietary intervention. There are no sensitive or specific tests to diagnose FPIAP and thus diagnosis is typically made based on clinical criteria. Managing FPIAP remains challenging due to the relative paucity of objective data to inform practice. This review aims to provide a foundation for an evidence-based approach to FPIAP management. Recent Findings Recent research suggests a significant role for gut microbiota dysbiosis in FPIAP pathogenesis, with associations observed in infants with an atopic predisposition. Notably, FPIAP in infancy may correlate with an elevated risk of developing IgE-mediated food allergies later in life, indicating a potential mechanistic link between these immune responses. Summary A period of watchful waiting may be appropriate in well-appearing infants. However, for children with persistent symptoms, management centers around a cow’s milk restricted diet during lactation and/or hypoallergenic formula, guided by a registered dietitian. Strongly consider a food challenge with the dietary trigger 2-4 weeks after restriction to confirm the diagnosis and prevent unnecessary restrictions.