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Nutrients
Volume 18
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10.3390/nu18010095
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Identifying Predictors for the Acquisition of Tolerance to Cow’s Milk Protein in Infants with Food Protein-Induced Allergic Proctocolitis (FPIAP): Multifactorial Analysis of Two Italian Cohorts

by
Andrea Scavella
1,
Cristina Ferrigno
2,
Mario Baù
1,
Alessandra Colombo
2,
Claudia Ivonne Tavernelli
1,
Marianna Zobele
2,
Roberta Borgetto
1,
Alessandra Maggi
2,
Alice Baronti
1,
Antonio Francone
1,
Gian Vincenzo Zuccotti
2,3,
Massimo Agosti
4,
Enza D’Auria
2,3,* and
Silvia Salvatore
5,*
1
Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy
2
Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
3
Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
4
Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
5
Pediatric Unit, Department of Medicine and Technological Innovation, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy
*
Authors to whom correspondence should be addressed.
Nutrients 2026, 18(1), 95; https://doi.org/10.3390/nu18010095 (registering DOI)
Submission received: 17 November 2025 / Revised: 21 December 2025 / Accepted: 25 December 2025 / Published: 27 December 2025
(This article belongs to the Special Issue Nutrition Management in Neonatal Health)
Review Reports Versions Notes

Abstract

Background/Objectives: Food protein–induced allergic proctocolitis (FPIAP) is a non–IgE-mediated gastrointestinal food allergy. Although tolerance to the culprit food is usually achieved within the first year of life, late acquisition occurs and remains poorly predictable. This study aimed to analyze clinical characteristics and explore factors that may potentially function as predictors of late tolerance acquisition to cow’s milk (CM). Methods: We conducted a cross-sectional study at two Italian pediatric clinics (2020–2024), including infants diagnosed with FPIAP. Clinical, dietary, and immunological variables; onset and duration of rectal bleeding (visible blood in the stools); and time to CM tolerance were analyzed. Late tolerance was defined as acquisition after 19 months according to the distribution of tolerance achievement in our population. Statistical analyses included χ2, Mann–Whitney U, Spearman’s correlation, and logistic regression. Results: Ninety-four infants were included (median age at onset 2.9 months [IQR 1.9–4.7]); 58 (62%) were exclusively breastfed and 18 (19%) were born preterm (<37 completed weeks of gestation). CM was the culprit food in all cases; tolerance was achieved in all infants at a median age of 12 months. Family history of atopy and atopic dermatitis were reported in 44% and 19% of infants, respectively. Late CM tolerance was associated with preterm birth, fortification of human milk, early antibiotic exposure, growth faltering, and recurrent infections. Logistic regression identified family history of atopy (OR 5.4 [95% CI 1.2–25.4]; p = 0.031), atopic dermatitis (OR 8.2 [1.7–40.7]; p = 0.010), rectal bleeding >18 days before elimination diet (OR 5.9 [1.3–27.7]; p = 0.023), and IgE sensitization (OR 6.4 [1.2–35.0]; p = 0.034) as factors that may potentially function as predictors of late tolerance acquisition to CM. Conclusions: Identification of factors that may potentially function as predictors of late tolerance acquisition to CM in infants with FPIAP may help providing a personalized clinical management for these patients.
Keywords: non-IgE-mediated food allergy; food protein-induced allergic proctocolitis; FPIAP; rectal bleeding; elimination diet; cow’s milk; food tolerance; infants non-IgE-mediated food allergy; food protein-induced allergic proctocolitis; FPIAP; rectal bleeding; elimination diet; cow’s milk; food tolerance; infants

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MDPI and ACS Style

Scavella, A.; Ferrigno, C.; Baù, M.; Colombo, A.; Tavernelli, C.I.; Zobele, M.; Borgetto, R.; Maggi, A.; Baronti, A.; Francone, A.; et al. Identifying Predictors for the Acquisition of Tolerance to Cow’s Milk Protein in Infants with Food Protein-Induced Allergic Proctocolitis (FPIAP): Multifactorial Analysis of Two Italian Cohorts. Nutrients 2026, 18, 95. https://doi.org/10.3390/nu18010095

AMA Style

Scavella A, Ferrigno C, Baù M, Colombo A, Tavernelli CI, Zobele M, Borgetto R, Maggi A, Baronti A, Francone A, et al. Identifying Predictors for the Acquisition of Tolerance to Cow’s Milk Protein in Infants with Food Protein-Induced Allergic Proctocolitis (FPIAP): Multifactorial Analysis of Two Italian Cohorts. Nutrients. 2026; 18(1):95. https://doi.org/10.3390/nu18010095

Chicago/Turabian Style

Scavella, Andrea, Cristina Ferrigno, Mario Baù, Alessandra Colombo, Claudia Ivonne Tavernelli, Marianna Zobele, Roberta Borgetto, Alessandra Maggi, Alice Baronti, Antonio Francone, and et al. 2026. "Identifying Predictors for the Acquisition of Tolerance to Cow’s Milk Protein in Infants with Food Protein-Induced Allergic Proctocolitis (FPIAP): Multifactorial Analysis of Two Italian Cohorts" Nutrients 18, no. 1: 95. https://doi.org/10.3390/nu18010095

APA Style

Scavella, A., Ferrigno, C., Baù, M., Colombo, A., Tavernelli, C. I., Zobele, M., Borgetto, R., Maggi, A., Baronti, A., Francone, A., Zuccotti, G. V., Agosti, M., D’Auria, E., & Salvatore, S. (2026). Identifying Predictors for the Acquisition of Tolerance to Cow’s Milk Protein in Infants with Food Protein-Induced Allergic Proctocolitis (FPIAP): Multifactorial Analysis of Two Italian Cohorts. Nutrients, 18(1), 95. https://doi.org/10.3390/nu18010095

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