Introduction: Food protein-induced allergic proctocolitis (FPIAP) is the most common non-IgE-mediated food allergy and it varies between 4% and 8% in infants. The aim of the study was to evaluate the potential association between FPIAP in infants and maternal daily consumption of homemade fermented foods (FFs) during pregnancy. Methods: Two hundred and seven infants were included in this case-control study, 106 with physician-diagnosed FPIAP (FPIAP group) and 101 age- and gender-matched healthy infants (control group), together with their mothers. The frequency and diversity of the 8 most consumed homemade FFs in traditional Turkish cuisine and daily maternal consumption of these during pregnancy were evaluated retrospectively using a structured questionnaire. Results: Rates of vaginal delivery, maternal smoking during pregnancy, educational status, and monthly household income were higher in the FPIAP group than the control group (p = 0.046, p = 0.014, p < 0.001, and p = 0.009, respectively). The 3 most common daily-consumed FFs during pregnancy were, in order, yogurt, cheese, and tarhana. The diversity of daily-consumed FFs during pregnancy (p = 0.004) and the consumption of the 3 most common FFs (p = 0.011) were lower in the FPIAP group than in the control group. Maternal smoking during pregnancy (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.19–7.41, p = 0.019) and a higher maternal educational status (OR: 3.34, 95% CI: 1.63–6.84, p = 0.001) increased the risk of FPIAP at multivariate logistic regression, while the diversity of maternal FF consumption was protective against FPIAP (OR: 0.75, 95% CI: 0.58–0.96, p = 0.025). Conclusion: Daily maternal consumption of yogurt, cheese, and tarhana during pregnancy was less common in FPIAP. The diversity of traditional Turkish homemade FFs may reduce the risk of FPIAP, whereas maternal smoking and a higher maternal educational status were associated with an increased risk of FPIAP.

Odze RD, Bines J, Leichtner AM, Goldman H, Antonioli DA. Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study.
Hum Pathol
. 1993;24(6):668–74.
El Mecherfi KE, Todorov SD, Cavalcanti de Albuquerque MA, Denery-Papini S, Lupi R, Haertlé T, et al. Allergenicity of fermented foods: emphasis on seeds protein-based products.
. 2020;9(6):1–19.
Prescott SL, Pawankar R, Allen KJ, Campbell DE, Sinn JKH, Fiocchi A, et al. A global survey of changing patterns of food allergy burden in children.
World Allergy Organ J
. 2013;6(1):21–12.
Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome and allergic proctocolitis.
Allergy Asthma Proc
. 2015 May–Jun;36(3):172–84.
Chehade M. IgE and non-IgE-mediated food allergy: treatment in 2007.
Curr Opin Allergy Clin Immunol
. 2007;7(3):264–8.
Lack G. Update on risk factors for food allergy.
J Allergy Clin Immunol
. 2012;129(5):1187–97.
Caplice E, Fitzgerald GF. Food fermentations: role of microorganisms in food production and preservation.
Int J Food Microbiol
. 1999;50(1–2):131–49.
Kabak B, Dobson AD. An introduction to the traditional fermented foods and beverages of Turkey.
Crit Rev Food Sci Nutr
. 2011;51(3):248–60.
Altay F, Karbancıoglu-Güler F, Daskaya-Dikmen C, Heperkan D. A review on traditional Turkish fermented non-alcoholic beverages: microbiota, fermentation process and quality characteristics.
Int J Food Microbiol
. 2013;167(1):44–56.
Marco ML, Sanders ME, Gänzle M, Arrieta MC, Cotter PD, De Vuyst L, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods.
Nat Rev Gastroenterol Hepatol
. 2021;18(3):196–208.
Tamang JP, Shin DH, Jung SJ, Chae SW. Functional properties of microorganisms in fermented foods.
Front Microbiol
. 2016 April;7:578–13.
Shiferaw Terefe N, Augustin MA. Fermentation for tailoring the technological and health related functionality of food products.
Crit Rev Food Sci Nutr
. 2020;60(17):2887–913.
Bell V, Ferrão J, Pimentel L, Pintado M, Fernandes T. One health, fermented foods, and gut microbiota.
. 2018;7(195):1–17.
Gille D, Schmid A, Walther B, Vergères G. Fermented food and non-communicable chronic diseases: a review.
. 2018;10(4):1–18.
Melini F, Melini V, Luziatelli F, Ficca AG, Ruzzi M. Health-promoting components in fermented foods: an up-to-date systematic review.
. 2019;11(5):1–24.
Şanlier N, Gökcen BB, Sezgin AC. Health benefits of fermented foods.
Crit Rev Food Sci Nutr
. 2019;59(3):506–27.
El-Ghaish S, Ahmadova A, Hadji-Sfaxi I, El Mecherfi KE, Bazukyan I, Choiset Y, et al. Potential use of lactic acid bacteria for reduction of allergenicity and for longer conservation of fermented foods.
Trends Food Sci Technol
. 2011;22(9):509–16.
Marrs T, Bruce KD, Logan K, Rivett DW, Perkin MR, Lack G, et al. Is there an association between microbial exposure and food allergy? A systematic review.
Pediatr Allergy Immunol
. 2013;24(4):311–20.e8.
Loo EXL, Ong L, Goh A, Chia AR, Teoh OH, Colega MT, et al. Effect of maternal dietary patterns during pregnancy on self-reported allergic diseases in the first 3 years of life: results from the GUSTO study.
Int Arch Allergy Immunol
. 2017;173(2):105–13.
Lee KH, Song Y, Wu W, Yu K, Zhang G. The gut microbiota, environmental factors, and links to the development of food allergy.
Clin Mol Allergy
. 2020;18(1):5–11.
Wang J, Zheng S, Yang X, Huazeng B, Cheng Q. Influences of non-IgE-mediated cow’s milk protein allergy-associated gut microbial dysbiosis on regulatory T cell-mediated intestinal immune tolerance and homeostasis.
Microb Pathog
. 2021;158(105020):105020.
Mennini M, Fiocchi AG, Cafarotti A, Montesano M, Mauro A, Villa MP, et al. Food protein-induced allergic proctocolitis in infants: literature review and proposal of a management protocol.
World Allergy Organ J
. 2020;13(10):100471.
Kim YH, Kim KW, Lee SY, Koo KO, Kwon SO, Seo JH, et al. Maternal perinatal dietary patterns affect food allergy development in susceptible infants.
J Allergy Clin Immunol Pract
. 2019;7(7):2337–47.e7.
Abrahamsson T, Wu RY, Jenmalm M. Gut microbiota and allergy : the importance of the pregnancy period.
Pediatr Res
. 2015;77(1):214–9.
Marko M, Pawliczak R. The role of microbiota in allergy development.
Alergologia Pol Pol J Allergol
. 2017;4(2):58–62.
Martin R, Makino H, Cetinyurek Yavuz A, Ben-Amor K, Roelofs M, Ishikawa E, et al. Early-life events, including mode of delivery and type of feeding, siblings and gender, shape the developing gut microbiota.
PLoS One
. 2016;11(6):e0158498–30.
Celik V, Beken B, Yazicioglu M, Ozdemir PG, Sut N. Do traditional fermented foods protect against infantile atopic dermatitis.
Pediatr Allergy Immunol
. 2019;30(5):540–6.
Miyake Y, Tanaka K, Okubo H, Sasaki S, Arakawa M. Maternal consumption of dairy products, calcium, and vitamin D during pregnancy and infantile allergic disorders.
Ann Allergy Asthma Immunol
. 2014;113(1):82–7.
Shoda T, Futamura M, Yang L, Narita M, Saito H, Ohya Y. Yogurt consumption in infancy is inversely associated with atopic dermatitis and food sensitization at 5 years of age: a hospital-based birth cohort study.
J Dermatol Sci
. 2017;86(2):90–6.
Venter C, Brown T, Shah N, Walsh J, Fox AT. Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: a UK primary care practical guide.
Clin Transl Allergy
. 2013;3(1):23–11.
Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report.
J Am Acad Dermatol
. 2011;64(1):175–92.
Walker RW, Clemente JC, Peter I, Loos RJF. The prenatal gut microbiome: are we colonized with bacteria in utero?
Pediatr Obes
. 2017;12 Suppl 1:3–17.
Miyake Y, Sasaki S, Tanaka K, Hirota Y. Dairy food, calcium and vitamin D intake in pregnancy, and wheeze and eczema in infants.
Eur Respir J
. 2010;35(6):1228–34.
Buyuktiryaki B, Kulhas Celik I, Erdem SB, Capanoglu M, Civelek E, Guc BU, et al. Risk factors influencing tolerance and clinical features of food protein-induced allergic proctocolitis.
J Pediatr Gastroenterol Nutr
. 2020;70(5):574–9.
Gorris A, Bustamante G, Mayer KA, Kinaciyan T, Zlabinger GJ. Cesarean section and risk of allergies in Ecuadorian children: a cross-sectional study.
Immun Inflamm Dis
. 2020;8(4):763–73.
Martin V, Virkud YV, Seay HL, Keet C, Shreffler WG, Yuan Q. A prospective assessment of food protein-induced allergic proctocolitis from the gmap healthy infant cohort.
J Allergy Clin Immunol
. 2019;143(2):AB136.
Buyukbayrak EE, Kaymaz O, Kars B, Karsidag AY, Bektas E, Unal O, et al. Caesarean delivery or vaginal birth: preference of Turkish pregnant women and influencing factors.
J Obstet Gynaecol
. 2010;30(2):155–8.
Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective cesarean section on maternal request: a systematic review.
J Matern Fetal Neonatal Med
. 2020;33(22):3867–72.
Tollånes MC, Thompson JM, Daltveit AK, Irgens LM. Cesarean section and maternal education; secular trends in Norway, 1967-2004.
Acta Obstet Gynecol Scand
. 2007;86(7):840–8.
Metsälä J, Lundqvist A, Kaila M, Gissler M, Klaukka T, Virtanen SM. Maternal and perinatal characteristics and the risk of cow’s milk allergy in infants up to 2 years of age: a case-control study nested in the finnish population.
Am J Epidemiol
. 2010;171(12):1310–6.
Mathias JG, Zhang H, Soto-Ramirez N, Karmaus W. The association of infant feeding patterns with food allergy symptoms and food allergy in early childhood.
Int Breastfeed J
. 2019;14(1):43–12.
Berdi M, de Lauzon-Guillain B, Forhan A, Castelli FA, Fenaille F, Charles MA, et al. Immune components of early breastmilk: association with maternal factors and with reported food allergy in childhood.
Pediatr Allergy Immunol
. 2019;30(1):107–16.
Adeyeye TE, Yeung EH, McLain AC, Lin S, Lawrence DA, Bell EM. Wheeze and food allergies in children born via cesarean delivery: the Upstate KIDS study.
Am J Epidemiol
. 2019;188(2):355–62.
Levin ME, Botha M, Basera W, Facey-Thomas HE, Gaunt B, Gray CL, et al. Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort.
J Allergy Clin Immunol
. 2020;145(1):415–26.
Yang HJ. Impact of perinatal environmental tobacco smoke on the development of childhood allergic diseases.
Korean J Pediatr
. 2016;59(8):319–27.
Noakes PS, Holt PG, Prescott SL. Maternal smoking in pregnancy alters neonatal cytokine responses.
. 2003;58(10):1053–8.
Haddeland U, Karstensen AB, Farkas L, Bø KO, Pirhonen J, Karlsson M, et al. Putative regulatory T cells are impaired in cord blood from neonates with hereditary allergy risk.
Pediatr Allergy Immunol
. 2005;16(2):104–12.
Hinz D, Bauer M, Röder S, Olek S, Huehn J, Sack U, et al. Cord blood Tregs with stable FOXP3 expression are influenced by prenatal environment and associated with atopic dermatitis at the age of one year.
. 2012;67:380–9.
Prescott SL. Effects of early cigarette smoke exposure on early immune development and respiratory disease.
Paediatr Respir Rev
. 2008;9(1):3–10.
Linnamaa P, Nieminen K, Koulu L, Tuomasjukka S, Kallio H, Yang B, et al. Pro-inflammatory and Th2-type cytokine responses in PBMC in infants are associated with parental smoking.
Clin Exp Allergy
. 2012;42(10):1472–8.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.