Allergic colitis natural history, complications and prognosis

Allergic colitis typically develops in early infancy. Allergic colitis is benign, resolving completely in most children without any sequelae. The infants with food protein-induced allergic proctocolitis are usually on exclusive breastfeeding while those with food protein-induced enterocolitis syndrome are often on infant formula. If left untreated, spontaneous resolution may occur in 20% of the children with allergic colitis without elimination of the triggering food. Most infants with allergic colitis will tolerate the offending food by 1 to 3 years of age.

• The symptoms of allergic colitis typically develops in early infancy (within the first two or three months of life). The infants with food protein-induced allergic proctocolitis are usually on exclusive breastfeeding while those with food protein-induced enterocolitis syndrome are often on infant formula. Typically, the episodes resolve within 48 to 96 hours following avoidance of the trigger protein. Spontaneous resolution of symptoms may occur in 20% of the children without elimination of the offending protein. Most infants with food protein-induced allergic proctocolitis will be able to tolerate the offending protein by 1 to 3 years of age, while those with food protein-induced enterocolitis syndrome tolerate the offending protein later usually by 2 to 5 years of age.^[1][2][3][4]

• The natural history of allergic colitis that develops in adolescence or early adulthood especially if due to solid food is poorly characterized with the resolution of symptoms often prolonged.^[5]

Complications of allergic colitis are more common with food protein-induced enterocolitis syndrome (FPIES) than food protein-induced allergic proctocolitis (FPIAP). The complications include:^[6][7]

• Dehydration
• Electrolyte imbalance
• Iron deficiency anemia
• Hypoalbuminemia (from protein-losing enteropathy)
• Failure to thrive (especially in infants with FPIES)

• The prognosis of allergic colitis is excellent when it presents in infancy.
• The disease is benign, self-limiting, and resolves completely, with the child outgrowing the allergy with age.
• The prognosis for allergic colitis that presents in adolescence or adulthood is not fully understood.^[1][3][6]

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