Food Protein-Induced Allergic Proctocolitis: The Effect of Maternal Diet During Pregnancy and Breastfeeding in a Mediterranean Population

Abstract

BackgroundThe aim of the current investigation was to explore the association of food protein-induced allergic proctocolitis (FPIAP) with the maternal diet during pregnancy and breastfeeding in Greek infants.MethodsA multicenter retrospective case-control study was conducted in 6 regions in Greece, with 96 mothers of infants with and 141 mothers of infants without a history of FPIAP. Maternal dietary habits during pregnancy and breastfeeding were evaluated with the following validated questionnaires: (a) The Mediterranean Diet Score and (b) The Mediterranean Oriented Culture-Specific Semi-Quantitative Food Frequency Questionnaire.ResultsFPIAP was associated with cow's milk (83.6%), egg (7.3%), wheat (6.4%), and beef (6.4%) in the maternal diet. Adherence to Mediterranean Diet was similar among the mothers. Mothers of FPIAP infants consumed more vegetables. Elastic net prediction models showed that, in this Mediterranean population, increased consumption during pregnancy and lactation of common allergens, whole grain products, homemade food, fish and shellfish, and fruits was associated with a decreased risk of FPIAP. Conversely, a high intake of vegetables, sugar and total fat, and non-stick/grilled cooking, were associated with increased risk of FPIAP, as was a high intake of salt and white flour during lactation only.ConclusionsComponents of a maternal Mediterranean Diet may protect against FPIAP when traditional cooking methods are adopted and fish, fruit, and whole wheat products are consumed frequently during pregnancy and breastfeeding.

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

“…Environmental and nutritional factors during pregnancy and breastfeeding may affect the development of FPIAP [ 17 ], as we reported in a previous study [ 11 ]. A maternal MedDiet, with large amounts of whole grain products, fish, shellfish, fruits and home-cooked food, has been shown to be associated with a lower risk of FPIAP [ 12 ] and other allergies [ 14 ], while increased intake of vegetable oils, margarine and “fast foods” appears to be related to a higher risk [ 12 , 18 ].…”

“…A retrospective, observational, multicenter study was conducted between May 2018 and November 2020 on 96 mothers and their breastfed infants with a diagnosis of FPIAP confirmed by a pediatric allergist, recruited from 6 regions in Greece Athens, Thessaloniki, Amaliada, Volos, Kavala and Kozani) with different environmental characteristics, as previously described [ 11 ].…”

“…FPIAP is characterized by inflammation of the distal colon in response to one or more food proteins, with no evidence of immunoglobulin E (IgE) involvement [ 9 ]. Milk, egg and soy are the foods most commonly implicated [ 10 , 11 ]. The association of symptoms with food protein antigens is confirmed by objective improvement following withdrawal of the suspected food antigen and, in some cases, recurrence following subsequent oral challenge [ 2 ].…”

“…In a case series in a Greek population, the most common trigger in breastfed infants was cow’s milk (83.6%), followed by egg (7.3%), wheat (6.4%) and beef (6.4%). Interestingly, a possible beneficial effect of maternal consumption of certain foods during pregnancy and breastfeeding in preventing FPIAP development (including whole grain products, fish, shellfish and fruits) was suggested [ 11 ].…”

Cow’s milk-induced gastrointestinal disorders: From infancy to adulthood

“…It usually presents with a bloody mucoid stool in a well-appearing healthy infant aged one to four weeks. It occurs mainly in exclusively breastfed infants (60%) and resolves when the mother eliminates CMP and soy proteins from their diet[ 45 ]. As skin allergy tests and IgE are negative in infants with FPIAP, the diagnosis is usually made by exclusion and confirmed with an elimination/rechallenge test with CMP or soymilk protein[ 46 ].…”