Brief Communication Allergic Proctocolitis Refractory to Maternal Oligoantigenic Diet in Exclusively Breast-fed Infants: a Clinical Observation

Background: Allergic proctocolitis (APC) is caused by food proteins, often but not exclusively of cow milk, transferred through lactation. The objective is to assess if patch tests can detect subgroups of patients requiring an aminoacid-based formula (AAF) due to multiple food allergy. Cases presentation: We have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. All patients underwent a colonoscopy, prick and patch test for foods and breast milk. A rectosigmoidoscopy was performed after 1 month of therapy with an AAF. Prick tests were negative. Patch tests were positive in all infants, with a multiple positivity in 7/14. The offending foods were breast milk (14/14), cow milk (7/14), soy (4/14), egg (3/14), rice (2/14), wheat (1/14). Rectosigmoidoscopy after 1 month was normal. Conclusion: These data suggest that patch test is a useful tool to identify subgroups of infants with multiple food allergy involving a delayed immunogenic mechanism and avoiding unnecessary maternal dietary restrictions before administering an AAF.