Allergic colitis physical examination

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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

Patients with allergic colitis may appear well in the case of food protein-induced allergic proctocolitis (FPIAP) or may appear lethargic when they have food protein-induced enterocolitis syndrome (FPIES). Physical examination of patients with FPIES is usually remarkable for signs of dehydration, pallor, and poor weight.

Physical Examination

Type of Allergic colitis	Physical Examination
Food protein-induced allergic proctocolitis	Child is usually well-appearing The weight and height of the child is appropriate for age Mild pallor may be noticed Child may be restless when having abdominal pain Stool contain streak of blood with or without mucus
Food protein-induced enterocolitis syndrome	Acute The child is dehydrated within a few hours after exposure to the offending protein The child is lethargic when severe May be in shock Pallor is observed, especially with frank bloody diarrhea The child may appear dusky Abdominal distention may be seen May develop edema
	Chronic Symptoms occur with a background chronic exposure The child's weight and height are low for the age May develop edema May have abdominal distension Signs of dehydration will also be observed following acute exposure

Diagnosis

• There is no definitive diagnostic criteria for allergic colitis. Diagnosis of allergic colitis is based on detailed clinical assessment (history and physical findings) and additional endoscopic findings for those with atypical presentation. The National Institute of Allergy and Infectious Diseases (NIAID) expert panel recommends a detailed medical history and physical examination to rule out any other possible cause for the symptoms, the absence of symptoms while avoiding the causative food, and recurrence of symptoms following an oral food challenge test to diagnose allergic colitis.
• Oral food allergy challenge test is considered the most important step in the diagnosis of allergic colitis. It could be single-blind, double-blind placebo-controlled challenge or open. The double-blind controlled challenge is more reliable, but in practice open challenge is most often performed.
• Recently, an international expert panel is working on evidence-based guidelines for diagnosis and management of allergic colitis to improve the care provided for patients.