Allergic colitis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]

Overview

The most common symptoms of allergic colitis is passage of blood streaked stool in an otherwise healthy young infant especially in FPIAP. History of failure to thrive may also be gotten in the infant with FPIES. There may be a family history of allergy.

History and Symptoms

Obtaining a detailed history is important in making diagnosis of allergic colitis. Complete history will help determine the cause and possible risk factors associated with the disease.

History

Specific history to ask include:

• When the symptoms started
• Type of food ingested
• Detailed description of the symptoms, such as stool pattern, number of times and presence or absence of blood in the stool; and vomiting
• Is the child thriving or ill looking
• Presence of abdominal pain
• Family history of allergy

Type of Allergic colitis	History and Symptoms
Food protein-induced allergic proctocolitis	Onset of symptoms is usually insidious in the first weeks to two months of life. This is modified by amount and duration of exposure to the offending protein Child is on exclusive breastfeeding History of passage blood streaked stool, which is loose or may be of normal consistency Despite passage of loose stools, there is typically no history of frank diarrhea History of occasional episode of vomiting History of abdominal pain or discomfort when defecating may be present History of atopy in the family
Food protein-induced enterocolitis syndrome	Chronic Typical presentation is that of chronic exposure to the trigger food with onset of symptoms developing insidiously in the first few weeks of life to as long as 1 year. Recurrent vomiting that may initially be unrelated to food intake Child is usually on infant formula only but occasionally infant formula with breastfeeding Infant formula is usually cow's milk or soy milk based formula History of recurrent episodes of vomiting few hours after ingestion of food History of diarrhea, which is blood stained Occasionally diarrhea stool may be completely bloody History of child losing weight or having poor weight gain History of atopy in the family
	Acute Symptoms occur following a period of avoidance of trigger food in a patient with a background history of chronic exposure. It may also follow intermittent exposures. Acute manifestation is seen in about 20% of patients with FPIES History of dramatic recurrent episodes of vomiting few hours (1 to 3 hours) after taking the offending food Vomiting is usually of large volume, may be projectile and bilious History of passage of diarrhea stool occurring shortly after the onset of vomiting. Diarrhea stool is usually of large volume and may or may not contain streaks of blood and mucus Occasionally diarrhea stool may become completely bloody History of atopy in the family