Introduction
Allergic colitis, also referred to as food protein–induced allergic proctocolitis, is an inflammatory condition of the colon triggered by an immune-mediated reaction to dietary proteins. It is most common in infants during the first months of life, often presenting with blood-streaked stools, fussiness, and sometimes diarrhea, despite otherwise normal growth and development. In adults, allergic colitis is less common and may be associated with food allergies, eosinophilic gastrointestinal disease, or immune dysregulation. The condition results from mucosal immune hypersensitivity, leading to inflammation and damage in the colonic lining. Treatment is aimed at removing the offending allergen and controlling inflammation.
Treatment Options and Doses
1. Elimination of Triggering Foods
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In infants who are breastfed: The mother should eliminate cow’s milk and soy proteins from her diet. Other allergens such as egg, wheat, or nuts may also be removed if symptoms persist.
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In formula-fed infants: Switch to an extensively hydrolyzed protein formula or, if symptoms continue, an amino acid–based formula.
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In older children and adults: Identification and avoidance of the specific allergen through elimination diets and food allergy testing.
2. Pharmacologic Treatment
Most cases improve significantly with dietary modification alone. However, in persistent or severe cases:
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Antihistamines: Used for associated allergic symptoms, though not usually first-line for colitis itself.
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Corticosteroids:
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Oral prednisone may be used in moderate to severe cases with ongoing bleeding or inflammation unresponsive to dietary changes.
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Typical short-course dose: 0.5 to 1 mg/kg/day orally, tapered as symptoms resolve.
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Topical corticosteroid enemas (hydrocortisone enemas, 100 mg rectally once daily) may be considered in localized colonic inflammation for older children or adults.
3. Probiotics and Supportive Care
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Lactobacillus rhamnosus GG has shown benefit in some infants by helping restore gut microbiota balance.
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Adequate hydration and nutritional support are important, especially in infants who may have feeding difficulties.
4. Monitoring and Reintroduction
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Many infants outgrow allergic colitis by 12 to 18 months of age.
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Supervised food challenges or gradual reintroduction of cow’s milk protein can be attempted after a symptom-free period, typically around one year of age.
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In adults, follow-up with a gastroenterologist and allergist is recommended for reintroduction planning and long-term management.
Key Considerations
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The mainstay of therapy is dietary elimination of the causative protein, which leads to symptom resolution in most cases within one to two weeks.
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Medications such as corticosteroids are reserved for severe, refractory, or atypical cases.
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Accurate diagnosis is important to avoid unnecessary dietary restrictions that could affect nutrition.
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Prognosis is excellent in infants, as tolerance often develops with age.
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