Food protein-induced proctocolitis

Food protein-induced proctocolitis (previously known as Cow's Milk Protein Intolerance)

  • Blood-tinged stools in an otherwise healthy infant
    • Ddx
      • Food protein-induced enterocolitis syndrome (FPIES) or Food protein-induced enteropathy
        • Consider if sicker (vomiting, diarrhea, weight loss)
      • Meckel's diverticulum
      • Necrotizing enterocolitis (NEC)
      • Intussusception
      • Anal fissure
  • Triggered by proteins from cow's milk, or occasionally soy or other foods, which are ingested through breast milk or standard infant formulas
    • Cow's milk – 76%
    • Egg – 16%
    • Soy – 6%
    • Corn – 2% (all in infants with multiple protein allergies).
    • Multiple (two of the above) – 8%.
    • No response to maternal dietary restriction – 8%; these infants improved after weaning to an extensively hydrolyzed or amino acid-based formula
  • Management:
    • Complete elimination of cow's milk (or other suspected antigen) from the diet, most will improve within a few days up to two weeks.
      • For breastfed infant, eliminate all milk protein (all dairy including butter) from the mother's diet, followed by egg and soy if still symptomatic
      • For formula-fed infants, an extensively hydrolyzed formula is used (eg. Enfamil Nutramigen, Similac Alimentum)
        • 5-10% may not respond - consider amino acid-based formula (eg. Neocate, PurAmino)
    • Resolves by one year of age in almost all infants