A pediatrician's guide to gastrointestinal allergies

Background. Cow's milk allergy is one of the most common food allergies in children. Gastrointestinal forms of food allergy require special attention from the pediatrician, but they still remain poorly recognized. Mostly, gastrointestinal forms of food allergies occur in children of the first years of life, and often have nonspecific signs – restless behavior, changes in stool patterns or regurgitation, which leads to an erroneous interpretation of clinical symptoms. The diagnosis is complicated by the delayed onset of symptoms due to the non-IgE-mediated type of allergic reaction in most cases, therefore, the lack of information content in the classical approach to diagnosing allergies. The two most common forms of gastrointestinal food allergies encountered in pediatric practice: allergic proctocolitis (FPIAP), characteristic of the first months of life and having the most favorable prognosis, and food protein enterocolitis syndrome (FPIES), often occurring in the second half of the year, against the background of the introduction of complementary foods. They do not require specialized diagnostic methods in a hospital setting. The elimination diet is the main tool for diagnosis and dietary therapy of these allergic conditions.

Objective. To provide a clinical algorithm for outpatient pediatricians on the management of children with non-IgE-mediated gastrointestinal food allergy.

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