Diagnosis and Management of Food Protein-Induced Allergic Proctocolitis in the pediatric age: A position paper from the Italian Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Italian Society for Pediatric Allergy and Immunology

Background: Food protein-induced allergic proctocolitis (FPIAP) is one of the most common phenotypes of food allergy in the first years of life. Several clinical aspects of FPIAP remain largely undefined, with a negative impact on its management. To bridge these gaps, a dedicated joint working group (WG) from the Italian Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP) was launched to provide practical evidence-based suggestions for the best diagnostic approach and management of this condition in pediatric age. Methods: This position paper was developed by a multidisciplinary panel of experts in the pediatric food allergy field from SIGENP and SIAIP. A structured literature review was conducted, and consensus was achieved through the Delphi process. Key topics include anamnestic factors, clinical presentation, diagnostic criteria, differential diagnosis, the role of laboratory and endoscopic investigations, dietary management, reintroduction strategies, and long-term outcomes. Results: The panel proposes a structured diagnostic approach emphasizing the role of a focused clinical history, response to the elimination diet, and recurrence of symptoms during the oral food challenge. Best strategies for the elimination diet in different clinical settings and for the appropriate use of diagnostic tools were also addressed. The paper underscores the importance of avoiding overdiagnosis and unnecessary diagnostic procedures and dietary restrictions, which can impact management, nutritional status, and quality of life. Conclusion: This position paper provides practical, evidence-based recommendations for the diagnosis and management of FPIAP in infants. The guidance aims to reduce diagnostic errors and delays and to promote appropriate, non-invasive, and family-centered care.