Can a 12 to 15 month old child develop Food Protein-Induced Allergic Proctocolitis (FPIAP) in reaction to chicken?

Can a 12-15 Month Old Develop FPIAP from Chicken?

No, chicken is not a recognized trigger for Food Protein-Induced Allergic Proctocolitis (FPIAP), and by 12-15 months of age, FPIAP has typically already resolved. FPIAP is a benign, self-limited condition that primarily affects young infants and resolves by 12 months in the majority of cases 1, 2.

Why Chicken is Not a Typical FPIAP Trigger

FPIAP is almost exclusively triggered by cow's milk protein, with occasional cases from soy and egg. The condition manifests as bloody, mucoid stools in otherwise healthy, well-appearing infants, typically presenting between 1-4 weeks of age 1, 2. The most common scenario involves:

• Cow's milk protein transmitted through breast milk in exclusively breastfed infants (up to 60% of cases) 2
• Cow's milk-based formula in formula-fed infants 3
• Rarely, soy protein or egg 3, 2

Chicken and other poultry are not documented triggers for FPIAP in the medical literature 1, 3, 2.

Age-Related Considerations

At 12-15 months, your child is beyond the typical age range for FPIAP:

• FPIAP usually presents between 1-4 weeks of age 2
• The median age of symptom onset is approximately 2 months 4
• Most cases resolve by 12 months of age, with tolerance to the culprit food achieved at a median age of 8 months 3, 2

What You Might Be Seeing Instead

If your 12-15 month old is experiencing bloody stools after eating chicken, consider these alternative diagnoses:

Food Protein-Induced Enterocolitis Syndrome (FPIES)

• Poultry (including chicken) CAN trigger FPIES, with cross-reactivity to other poultry occurring in less than 40% of cases 5
• FPIES presents differently than FPIAP: profuse, repetitive vomiting 1-4 hours after ingestion, often with lethargy and dehydration 5, 2
• Diarrhea (which may be bloody) typically develops within 24 hours 5
• Solid food-induced FPIES typically presents between 6-12 months of age 5

IgE-Mediated Food Allergy

• Immediate reactions (within minutes to 2 hours) with hives, facial swelling, respiratory symptoms, or anaphylaxis 6
• Can develop even in children who previously tolerated the food 7

Other Gastrointestinal Conditions

• Infectious gastroenteritis, anal fissures, or other structural/inflammatory bowel conditions should be excluded 5

Clinical Approach

If your child has bloody stools after eating chicken:

1. Document the timing and nature of symptoms - FPIES causes vomiting 1-4 hours post-ingestion, while FPIAP causes bloody stools without systemic symptoms 5, 1
2. Assess for systemic symptoms - lethargy, dehydration, or pallor suggest FPIES rather than FPIAP 5, 2
3. Consider supervised food challenge if the diagnosis is unclear, as history alone may be insufficient 5
4. Consult an allergist for proper evaluation, especially given the atypical trigger and age 5

Important Caveats

• While tolerance to one food in a group (like other meats) suggests tolerance to similar foods, poultry can still trigger reactions in children with solid food allergies 5, 6
• Children with a history of cow's milk or soy FPIAP have an increased risk of reactions to solid foods (less than 16%), though this typically manifests as FPIES rather than continued FPIAP 5
• Some children with non-IgE-mediated allergies like FPIAP can later develop IgE-mediated allergies to the same or different foods 7, 2

Bottom line: Chicken does not cause FPIAP, and at 12-15 months, FPIAP should have already resolved. If your child is having bloody stools after eating chicken, consider FPIES or other diagnoses and seek evaluation by an allergist.