Proposal for management of the infant with suspected food protein-induced allergic proctocolitis

we hypothesized a different management of child with suspected FPIAP, easier regarding the diet to follow. The management pathway illustrated in Figure 1 is different depending on whether duration of hematochezia is less than/equal to 1 month or higher. We chose 1 month as cutoff because this is the sum of the maximum duration (21 days) of hematochezia during follow- up in children randomly assigned to continue their normal diet and the mean duration (10 days) of bloody stools before admission in the study of Arvola et al4 The most important points of our proposal are two: • In case of hematochezia with duration less than or equal 1 month, we suggest waiting for the spontaneous resolution without elimination diet; • In cases of a duration of more than 1 month, we suggest an elimination diet and, if hematochezia disappears, we suggest a challenge.