2025 – PAGE 333 – INFECTIOUS DISEASES

(DOUBLE TAKE) FOOD PROTEIN INDUCED PROCTITIS/COLITIS

Food Protein Induced Proctitis/Colitis is another disorder that is NOT IgE mediated so does not need allergy testing. It occurs in the lower GI tract and the main sign is blood in the stools.

• • More common in breastfed infants due to cow’s milk protein in the mother’s diet
  • Babies are usually well other than having blood in the stools
• TREATMENT: Same as for food protein induced enteropathy. Even small amounts of milk protein in mom’s diet can cause problems, so have her check the contents of everything she eats. If eliminating milk doesn’t work, try eliminating eggs, soy, then consult a gastroenterologist. Typically resolves once the GI tract matures, although some food sensitivities may remain.
• PEARL: “This is an “-ITIS” of lower GI tract. These kids appear generally well, but usually present with blood and/or mucus in the stool. It’s due to an intolerance of a protein in their diet. Can be seen in breastfed infants who have a cow milk intolerance. Moms must remove milk from their diet. Kids generally do well later in life when cow’s milk is brought back into their diet.

(DOUBLE TAKE) FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES)

Food Protein Induced Enterocolitis Syndrome (FPIES) is the other non-IgE mediated food intolerance in infants. Its chronic form is similar to food protein induced enteropathy, with vomiting, diarrhea, and malabsorption. The acute form, however, is more dramatic, with severe vomiting ± diarrhea, often leading to lethargy and a shock-like state. Occurs 1–3 hours after ingestion of offending food. Cow’s milk and soy are the most common triggers but solids, especially RICE, are also frequent. Typically resolves once the GI tract matures, although some food sensitivities may remain.

• PEARL: The exact mechanism is still not known. Seems to be an allergic type of sensitization. Kids have a delayed reaction at 1-3 hours after exposure which results in tons of vomiting, diarrhea and more. Can even look listless and septic. Cow’s milk and soy are the biggest culprits. For older kids, rice and some other solids can be the culprits. They usually to outgrow this condition.

(DOUBLE TAKE) LACTOSE INTOLERANCE (AKA LACTASE DEFICIENCY)

It is not common for kids < 5 years old to have lactose intolerance (AKA lactase deficiency). So, for the pediatric boards, if the child is less than 5 years of age, suspect a different diagnosis!

• SYMPTOMS: Diarrhea ± abdominal pain.
• The HYDROGEN BREATH TEST can be used to help diagnose a lactase deficiency (as well as bacterial overgrowth). When the patient takes a carbohydrate load; if he or she is unable to digest the carbs because of a lack of lactase, the bacteria will digest the carbs and release hydrogen (which can be measured in the breath).
• TREATMENT: SOY milk. It does not contain lactose. It contains sucrose.
• PEARLS: Stool is NOT malodorous and does NOT have food particles. These patients do NOT vomit and do NOT have an associated rash. consider the diagnosis of an ALLERGY if you’re presented with a patient with such symptoms.
• MNEMONICS: “LACTose comes from the LACTating breasts of women and cows, NOT from soy beans.”