{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T01:36:55Z","timestamp":1779154615012,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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\u2019s milk (CM). Methods: We conducted a cross-sectional study at two Italian pediatric clinics (2020\u20132024), 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 \u03c72, Mann\u2013Whitney U, Spearman\u2019s correlation, and logistic regression. Results: Ninety-four infants were included (median age at onset 2.9 months [IQR 1.9\u20134.7]); 58 (62%) were exclusively breastfed and 18 (19%) were born preterm (&lt;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\u201325.4]; p = 0.031), atopic dermatitis (OR 8.2 [1.7\u201340.7]; p = 0.010), rectal bleeding &gt;18 days before elimination diet (OR 5.9 [1.3\u201327.7]; p = 0.023), and IgE sensitization (OR 6.4 [1.2\u201335.0]; 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.<\/jats:p>","DOI":"10.3390\/nu18010095","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:47:27Z","timestamp":1766998047000},"page":"95","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Predictors for the Acquisition of Tolerance to Cow\u2019s Milk Protein in Infants with Food Protein-Induced Allergic Proctocolitis (FPIAP): Multifactorial Analysis of Two Italian Cohorts"],"prefix":"10.3390","volume":"18","author":[{"given":"Andrea","family":"Scavella","sequence":"first","affiliation":[{"name":"Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7211-6055","authenticated-orcid":false,"given":"Cristina","family":"Ferrigno","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Ba\u00f9","sequence":"additional","affiliation":[{"name":"Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia Ivonne","family":"Tavernelli","sequence":"additional","affiliation":[{"name":"Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Zobele","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Borgetto","sequence":"additional","affiliation":[{"name":"Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Maggi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Baronti","sequence":"additional","affiliation":[{"name":"Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Francone","sequence":"additional","affiliation":[{"name":"Post Graduate School of Pediatrics, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-9874","authenticated-orcid":false,"given":"Gian Vincenzo","family":"Zuccotti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1828-821X","authenticated-orcid":false,"given":"Massimo","family":"Agosti","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2750-5810","authenticated-orcid":false,"given":"Enza","family":"D\u2019Auria","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4339-556X","authenticated-orcid":false,"given":"Silvia","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Department of Medicine and Technological Innovation, Hospital \u201cF. Del Ponte\u201d, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/j.jaci.2015.03.025","article-title":"Non\u2013IgE-mediated gastrointestinal food allergy","volume":"135","author":"Katz","year":"2015","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Tran, K.L., Wisner, E.L., Jeha, G.M., and Wall, L.A. (2024). Development of IgE-mediated food allergies in children with history of food protein-induced allergic proctocolitis: A series of five cases. Front. 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