1
|
Hayashi D, Yoshida K, Akashi M, Kajita N, Tatsumoto C, Ishii T, Koike Y, Horimukai K, Kinoshita M, Hamahata Y, Nishimoto H, Sakihara T, Arakaki Y, Hara M, Noguchi E, Morita H. Differences in Characteristics Between Patients Who Met or Partly Met the Diagnostic Criteria for Food Protein-Induced Enterocolitis Syndrome (FPIES). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1831-1839.e1. [PMID: 38492664 DOI: 10.1016/j.jaip.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/24/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Some patients with food protein-induced enterocolitis (FPIES)-like allergy do not completely fulfill the diagnostic criteria of the international consensus guideline for FPIES. However, it is unclear whether such FPIES-like patients represent a completely different population from FPIES. OBJECTIVE This study aimed to clarify differences in characteristics between patients with FPIES who fully met diagnostic criteria and those who partly met them. METHODS This was a cross-sectional study using data at the time of registration in multicenter, prospective studies of patients with FPIES in Japan. Children who had delayed emesis within 1 to 4 hours and/or diarrhea within 5 to 10 hours after ingestion of food were recruited between March 2020 and February 2022. We examined their compatibility with the diagnostic criteria of the international consensus guideline and their detailed clinical characteristics, including trigger foods, the serving size that elicited symptoms, and antigen-specific IgE antibody titers. RESULTS Of the 225 patients with FPIES, 140 fully met the diagnostic criteria whereas 79 patients did not fully meet them but demonstrated reproducible symptoms. The frequencies of pallor, lethargy, and diarrhea were significantly higher in those who met the criteria fully, whereas the age at onset, trigger foods, comorbidity, and perinatal information were comparable. Analysis of patients with FPIES to hen's egg revealed significantly higher levels of egg white- and egg yolk-specific IgE in patients who partly met criteria, whereas the serving size eliciting symptoms was comparable. CONCLUSIONS Patients who partly met the diagnostic criteria may have a milder phenotype of FPIES, but this needs to be validated in further studies using biomarkers reflecting the pathophysiology.
Collapse
Affiliation(s)
- Daisuke Hayashi
- Department of Pediatrics, Tsukuba Medical Center Hospital, Ibaraki, Japan; Department of Medical Genetics, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koichi Yoshida
- Department of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masayuki Akashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Kajita
- Department of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Tomo Ishii
- Department of Pediatrics, NHO Tochigi Medical Center, Tochigi, Japan
| | - Yumi Koike
- Department of Allergy, Nagano Children's Hospital, Nagano, Japan
| | - Kenta Horimukai
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Misako Kinoshita
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Yuko Hamahata
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Hajime Nishimoto
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Yohei Arakaki
- Department of Pediatrics, Naha City Hospital, Okinawa, Japan
| | - Monami Hara
- Department of Medical Genetics, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Emiko Noguchi
- Department of Medical Genetics, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Allergy Center, National Center for Child Health and Development, Tokyo, Japan.
| |
Collapse
|
2
|
Haddad C, Banerjee A, Eubanks J, Rana R, Rider NL, Pompeii L, Anvari S. A Second Slice of FPIES: A Single-Center Reappraisal of Pediatric FPIES. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00423-9. [PMID: 38685476 DOI: 10.1016/j.jaip.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is being increasingly recognized as a non-IgE-mediated food allergy; however, it remains unclear if and how the presentation, diagnosis, and management of this disease has changed in recent years. OBJECTIVE To reappraise the FPIES cohort at a large US pediatric tertiary referral center. METHODS We performed a retrospective chart review of pediatric patients with FPIES (International Classification of Diseases, Tenth Revision code K52.21) diagnosed in our allergy/immunology clinics between 2018 and 2022. RESULTS There were 210 children diagnosed with FPIES. Most were White (73.8%), non-Hispanic (71.4%), and male (54.3%) with private insurance (77.6%). Cow's milk was the most common food trigger (35.2%), with the earliest median age of onset of 5 months. The atypical FPIES rate was 13.8%. FPIES was accurately diagnosed in 54.3% at the first medical contact. The oral food challenge pass rate was 73.5%. The rate of trigger resolution at 36 months was 77%. CONCLUSIONS By comparing trends from a previous and current FPIES cohort, we were able to assess the potential impact of various guidelines and practice changes on the diagnosis and management of FPIES at our center. Milk and oat surpassed rice as the most common FPIES triggers; peanut and egg emerged as new FPIES triggers; there was a shorter time to diagnosis and an increased rate of atypical FPIES. Our findings reflect earlier recognition of FPIES and prompt allergy/immunology referral from community physicians, implementation of recent medical society guidelines for infant feeding practices, and growing clinical expertise of allergists at our center.
Collapse
Affiliation(s)
- Cynthia Haddad
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Ankona Banerjee
- Baylor College of Medicine, Department of Pediatrics, Division of Epidemiology, Houston, Texas
| | - Joshua Eubanks
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas; Baylor College of Medicine, Texas Children's Hospital, Division of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Ruchit Rana
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas; Baylor College of Medicine, Texas Children's Hospital, Division of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Nicholas L Rider
- Liberty University College of Osteopathic Medicine, Department of Pediatrics, Division of Clinical Informatics, Lynchburg, Va
| | - Lisa Pompeii
- Division of Patient Services Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sara Anvari
- Baylor College of Medicine, Department of Pediatrics, Houston, Texas; Baylor College of Medicine, Texas Children's Hospital, Division of Immunology, Allergy and Retrovirology, Houston, Texas; Texas Children's Hospital, William T. Shearer Center for Human Immunobiology, Houston, Texas.
| |
Collapse
|
3
|
Anvari S, Ruffner MA, Nowak-Wegrzyn A. Current and future perspectives on the consensus guideline for food protein-induced enterocolitis syndrome (FPIES). Allergol Int 2024; 73:188-195. [PMID: 38326194 DOI: 10.1016/j.alit.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/06/2024] [Indexed: 02/09/2024] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy presenting with delayed onset of projectile vomiting in the absence of cutaneous and respiratory symptoms. The pathophysiology of FPIES remains poorly characterized. The first international consensus guidelines for FPIES were published in 2017 and provided clinicians with parameters on the diagnosis and treatment of FPIES. The guidelines have served as a resource in the recognition and management of FPIES, contributing to an increased awareness of FPIES. Since then, new evidence has emerged, shedding light on adult-onset FPIES, the different phenotypes of FPIES, the recognition of new food triggers, center-specific food challenge protocols and management of acute FPIES. Emerging evidence indicates that FPIES impacts both pediatric and adult population. As a result, there is growing need to tailor the consensus guidelines to capture diagnoses in both patient groups. Furthermore, it is crucial to provide food challenge protocols that meet the needs of both pediatric and adult FPIES patients, as well as the subset of patients with atypical FPIES. This review highlights the evolving clinical evidence relating to FPIES diagnosis and management published since the 2017 International FPIES Guidelines. We will focus on areas where recent published evidence may support evolution or revision of the guidelines.
Collapse
Affiliation(s)
- Sara Anvari
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
| | - Melanie A Ruffner
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, NY, USA; Department of Pediatrics Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
| |
Collapse
|
4
|
Suzuki H, Morisaki N, Nagashima S, Matsunaga T, Matsushita S, Iino A, Tanaka Y, Nishimori H, Munakata S, Kemmochi M, Murakami Y, Sato M, Toyokuni K, Yamamoto-Hanada K, Morita H, Fukuie T, Yamada Y, Ohtsuka Y, Arai K, Ohya Y, Saito H, Matsumoto K, Nomura I. A nationwide survey of non-IgE-mediated gastrointestinal food allergies in neonates and infants. Allergol Int 2024; 73:264-274. [PMID: 37914545 DOI: 10.1016/j.alit.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Non-IgE-mediated gastrointestinal food allergies (non-IgE-GIFAs) seem to be increasing rapidly worldwide. However, nationwide studies have been limited to food-protein-induced enterocolitis (FPIES) and food-protein-induced allergic proctocolitis (FPIAP), with little attention to other non-IgE-GIFA subgroups. The aim of this study was to elucidate the clinical features of all patients with non-IgE-GIFAs, not just certain subgroups. METHODS We conducted a nationwide cross-sectional survey of non-IgE-GIFAs in Japan from April 2015 through March 2016. A questionnaire was sent to hospitals and clinics throughout Japan. The questionnaire asked about the number of physician-diagnosed non-IgE-GIFA patients, the status of fulfillment of the diagnostic criteria, tentative classification into 4 clusters based on the initial symptoms, the day of onset after birth, complications, and the suspected offending food(s). RESULTS The response rate to that questionnaire was 67.6% from hospitals and 47.4% from clinics. Analyses were conducted about "diagnosis-probable" patient cohort (n = 402) and the "diagnosis-confirmed" patients (n = 80). In half of the reported non-IgE-GIFA patients, onset occurred in the neonatal period. The patients were evenly distributed among 4 non-IgE-GIFA clusters. In Cluster 1, with symptoms of vomiting and bloody stool, the onset showed a median of 7 days after birth, which was the earliest among the clusters. Cow's milk was the most common causative food. CONCLUSIONS In half of the patients, the onset of non-IgE-GIFAs was in the neonatal period. This highlights the importance of studying the pathogenesis in the fetal and neonatal periods.
Collapse
Affiliation(s)
- Hiroko Suzuki
- National Research Institute for Child Health and Development, Division of Eosinophilic Gastrointestinal Disorders, Tokyo, Japan; Todachuo General Hospital, Department of Pediatrics, Saitama, Japan
| | - Naho Morisaki
- National Center for Child Health and Development, Department of Social Medicine, Tokyo, Japan
| | - Saori Nagashima
- National Research Institute for Child Health and Development, Division of Eosinophilic Gastrointestinal Disorders, Tokyo, Japan
| | | | - Shoko Matsushita
- Tokyo Metropolitan Children's Medical Center, Department of Allergy, Tokyo, Japan
| | - Akira Iino
- Tokyo Metropolitan Children's Medical Center, Department of Allergy, Tokyo, Japan
| | - Yuichiro Tanaka
- National Center for Child Health and Development, Department of General Pediatrics and Interdisciplinary Medicine, Tokyo, Japan
| | - Hisashi Nishimori
- Mie Prefectural General Medical Center, Department of Pediatrics, Mie, Japan
| | - Shun Munakata
- Nagano Children's Hospital, Department of Neonatology, Nagano, Japan
| | - Manabu Kemmochi
- Kitasato University Hospital, Department of Pediatrics, Kanagawa, Japan
| | - Yoshitaka Murakami
- Ehime Prefectural Imabari Hospital, Department of Pediatrics, Ehime, Japan
| | - Miori Sato
- National Center for Child Health and Development, Allergy Center, Tokyo, Japan
| | - Kenji Toyokuni
- National Center for Child Health and Development, Allergy Center, Tokyo, Japan
| | | | - Hideaki Morita
- National Research Institute for Child Health and Development, Department of Allergy and Clinical Immunology, Tokyo, Japan
| | - Tatsuki Fukuie
- National Center for Child Health and Development, Allergy Center, Tokyo, Japan
| | - Yoshiyuki Yamada
- Tokai University School of Medicine, Department of Pediatrics, Kanagawa, Japan
| | - Yoshikazu Ohtsuka
- Juntendo University School of Medicine, Department of Pediatrics and Adolescent Medicine, Tokyo, Japan
| | - Katsuhiro Arai
- National Center for Child Health and Development, Allergy Center, Tokyo, Japan; National Center for Child Health and Development, Division of Gastroenterology, Tokyo, Japan
| | - Yukihiro Ohya
- National Center for Child Health and Development, Allergy Center, Tokyo, Japan
| | - Hirohisa Saito
- National Research Institute for Child Health and Development, Department of Allergy and Clinical Immunology, Tokyo, Japan
| | - Kenji Matsumoto
- National Research Institute for Child Health and Development, Department of Allergy and Clinical Immunology, Tokyo, Japan
| | - Ichiro Nomura
- National Research Institute for Child Health and Development, Division of Eosinophilic Gastrointestinal Disorders, Tokyo, Japan; National Center for Child Health and Development, Allergy Center, Tokyo, Japan.
| |
Collapse
|
5
|
Akashi M, Kaburagi S, Kajita N, Morita H. Heterogeneity of food protein-induced enterocolitis syndrome (FPIES). Allergol Int 2024; 73:196-205. [PMID: 38553113 DOI: 10.1016/j.alit.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy with gastrointestinal symptoms such as vomiting and diarrhea. The development of international consensus guidelines for the diagnosis and management of FPIES in 2017 enabled us to compare patients worldwide, regardless of geographic variation in disease features. As a result, it has become clear that there is heterogeneity among patients with FPIES or that there are cases that partly fit the diagnostic criteria for FPIES but have different characteristics. This review highlights the heterogeneity in FPIES characteristics in terms of trigger foods, the age of onset, differences in geographic regions, and symptoms; it further proposes four disease entities, including acute FPIES in children, acute FPIES in adults, chronic FPIES, and early-onset neonatal FPIES, depending on the age of onset and presumed pathophysiology. The major symptoms at onset and trigger foods differ in acute FPIES in children, acute FPIES in adults, and chronic FPIES, whereas the disease entities may share a similar pathophysiology. Early-onset neonatal FPIES may have a different pathophysiology than acute or chronic FPIES, and may not necessarily fulfil the full diagnostic criteria for acute or chronic FPIES described in the international consensus guidelines. Due to the similarity in symptoms, early-onset neonatal FPIES may sometimes be misdiagnosed as necrotizing enterocolitis. We aim to increase awareness of FPIES among medical staff in pediatrics, neonatology, and internal medicine and promote research, to gain a better understanding of the heterogeneity and pathophysiology of FPIES.
Collapse
Affiliation(s)
- Masayuki Akashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Sachiko Kaburagi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Kajita
- Department of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Allergy Center, National Center for Child Health and Development, Tokyo, Japan.
| |
Collapse
|
6
|
Nunes de Castilho Santos L. [Differential diagnosis in food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:260-264. [PMID: 38506869 DOI: 10.29262/ram.v70i4.1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
It is important to establish the differential diagnosis of food allergy with other disorders, for example: toxic reactions that occur in any person exposed to a sufficient amount of some allergen, and non-toxic reactions that depend on individual susceptibility (food allergy or intolerance). The differential diagnosis is decisive to establish the appropriate treatment. Food intolerance involves adverse reactions to foods without any immunological response involved, and commonly manifests with gastrointestinal symptoms (malaise, abdominal pain or diarrhea). Food allergy is an exaggerated reaction of the immune system, often mediated by IgE, that can trigger serious symptoms (hives, inflammation, respiratory distress, even anaphylaxis). The complex thing is because the symptoms sometimes overlap. To establish an accurate diagnosis, exhaustive clinical evaluation, laboratory tests and, in some cases, controlled provocation tests are required. It is important to understand these distinctions, because treatment and management vary significantly. Food intolerance involves the elimination or reduction of the food that triggers the allergic reaction and requires rigorous measures (complete avoidance of the allergen and availability of epinephrine in cases of severe reactions).
Collapse
Affiliation(s)
- Liziane Nunes de Castilho Santos
- Alergólogo e Inmunólogo; Responsable Técnico y Profesor del sector de Alergia e Inmunología del Instituto Nacional de Salud de la Mujer, del Niño y del Adolescente Fernandes Figueira IFF/Fiocruz,
| |
Collapse
|
7
|
Rojo Gutiérrez MI, Ballesteros González D, Ortiz Durán AK. [Non-IgE-mediated food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:269-279. [PMID: 38506871 DOI: 10.29262/ram.v70i4.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
Food allergy is an immune response to proteins in food. It usually affects 8% of children and 2% of adults in Western countries. Non-IgE-mediated food allergy mainly affects the gastrointestinal tract. Gastrointestinal food allergies are classified, by their underlying pathogenesis, as: IgE-mediated, non-IgE-mediated, or mixed. The symptoms of patients with food protein-induced allergic proctocolitis originate from local inflammation of the distal colon, which causes hematochezia in neonates. It can affect the entire gastrointestinal tract and cause symptoms of intractable emesis, with subsequent metabolic disorders and hypovolemic shock. Food protein-induced enterocolitis syndrome is a non-IgE-mediated allergy that usually appears in childhood, with prolonged repetitive vomiting, starting 1 to 4 hours after ingestion of food. The manifestation in adults is usually triggered by the consumption of shellfish. Atopic diseases affect 40-60% of patients with food protein- induced enterocolitis syndrome, including 40-50% of those with food protein-induced enteropathy and proctocolitis. Probiotics (Lactobacillus GG) can alleviate the symptoms of allergic proctocolitis induced by food proteins, by altering the composition of the intestinal microbiota. Fecal microbiota transplantation (FMT) can change intestinal microecology efficiently compared to food or probiotics.
Collapse
Affiliation(s)
- María Isabel Rojo Gutiérrez
- Alergóloga e Inmunóloga clínica, Máster en Ciencias y Educación; Miembro de la Mesa Directiva de SLAAI; miembro activo del Colegio Mexicano de Inmunología Clínica y Alergia; Directora de Alergología en la Unidad Médica Zúrich, Ciudad de
| | - Diego Ballesteros González
- Médico Cirujano y Partero, Escuela Superior de Medicina, Instituto Politécnico Nacional; Alergia e inmunología clínica, Hospital Juárez de México
| | | |
Collapse
|
8
|
McWilliam V, Netting MJ, Volders E, Palmer DJ. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow's milk allergy. World Allergy Organ J 2023; 16:100830. [PMID: 38020284 PMCID: PMC10656250 DOI: 10.1016/j.waojou.2023.100830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Cow's milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow's milk allergy, it is critical to examine the evidence for and against any form of cow's milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow's milk proteins detectable in human milk cause infant cow's milk allergy symptoms. Current clinical practice recommendations advise a 2-4 week trial of maternal cow's milk dietary elimination for: a) IgE-mediated cow's milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow's milk allergy; and c) infants with moderate to severe eczema/atopic dermatitis, unresponsive to topical steroids and sensitized to cow's milk protein. There should be a clear plan for home reintroduction of cow's milk into the maternal diet for a period of 1 week to determine that the cow's milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow's milk reintroduction. The evidence base to support the use of maternal cow's milk avoidance for the treatment of a breastfed infant with cow's milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow's milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow's milk allergy maternal cow's milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essential.
Collapse
Affiliation(s)
- Vicki McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Merryn J. Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Nutrition Department, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Evelyn Volders
- Nutrition, Dietetics & Food, Monash University, Clayton, Vic, Australia
| | - Debra J. Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
9
|
Chow SJ, McWilliam V, Koplin JJ, Perrett KP. Australian Infant Food Allergy Emergency Presentations Following Updated Early Food Introduction Guidelines. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3473-3477. [PMID: 37479113 DOI: 10.1016/j.jaip.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND The Australasian Society of Clinical Immunology and Allergy food allergy prevention guidelines were updated in 2016 to recommend home introduction of allergenic foods actively in the first year of life, including to infants at high risk of allergy. An important consideration for parents and providers is whether this practice increases food allergy reactions or anaphylaxis. OBJECTIVE We aimed to determine whether the 2016 update of food allergy prevention guidelines was associated with an increase in food allergy or anaphylaxis emergency department (ED) presentations. METHODS We obtained hospital electronic medical records for infants aged 4 to 12 months who attended the Royal Children's Hospital Melbourne ED in 2015 or in 2018 with a presenting problem or an encounter diagnosis of food allergy or anaphylaxis. RESULTS Emergency department presentations owing to food allergy increased from 1.0% (95% CI, 0.85-1.23) in 2015 to 1.4% (95% CI, 1.22-1.67) in 2018 (P = .006). There was no increase in the number of anaphylaxis presentations (28 in 2015 and 22 in 2018) or peanut anaphylaxis presentations (three in 2015 and three in 2018). Overall, the proportion of food allergy presentations attributed to IgE-mediated food allergy was similar (82.1% in 2015 and 84.1% in 2018), whereas peanut allergy presentations increased slightly, although not statically significantly, from 14.6% to 21.2% (P = .09). Food protein-induced enterocolitis syndrome ED presentations were five in 2015 (4.3%) and 12 in 2018(7.6%), although not statistically significant (P = .25). CONCLUSIONS Changes to food allergy prevention guidelines recommending the earlier introduction of allergenic food may have led to a small increase in ED presentations for food allergy but not anaphylaxis.
Collapse
Affiliation(s)
- Sing-Jill Chow
- Population Allergy Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vicki McWilliam
- Population Allergy Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Population Allergy Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Kirsten P Perrett
- Population Allergy Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
10
|
McIntyre A, Baker MG, Singh AM. Reply to "Recurrences in food protein-induced enterocolitis syndrome: Let's get the label right". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3283-3284. [PMID: 37805229 DOI: 10.1016/j.jaip.2023.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Amanda McIntyre
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Mary Grace Baker
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Pediatric Allergy & Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anne Marie Singh
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| |
Collapse
|
11
|
Mastrorilli C, Arasi S, Barni S, Caimmi D, Chiera F, Comberiati P, Dinardo G, Giannetti A, Gismondi M, Gracci S, Paravati F, Pelosi U, Miraglia Del Giudice M, Bernardini R, Pecoraro L. IgE-Mediated and Non-IgE-Mediated Fish Allergy in Pediatric Age: A Holistic Approach-A Consensus by Diagnostic Commission of the Italian Society of Pediatric Allergy and Immunology. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1651. [PMID: 37763770 PMCID: PMC10537060 DOI: 10.3390/medicina59091651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Fish is one of the "big nine" foods triggering allergic reactions. For this reason, fish allergens must be accurately specified on food labels. Fish allergy affects less than 1% of the world population, but a higher prevalence is observed in pediatric cohorts, up to 7%. Parvalbumin is the main fish allergen found in the muscles. In childhood, sensitization to fish allergens occurs most frequently through the ingestion of fish, rarely transcutaneously or by inhalation. Fish allergy symptoms usually appear within two hours of the allergen contact. The diagnosis begins with the collection of the history. If it is suggestive of fish allergy, prick tests or the measurement of serum-specific IgE should be performed to confirm the suspicion. The oral food challenge is the gold standard for the diagnosis. It is not recommended in case of a severe allergic reaction. It is important to make a differential diagnosis with anisakiasis or scombroid poisoning, which have overlapping clinical features but differ in pathogenesis. Traditionally, managing fish allergy involves avoiding the triggering species (sometimes all bony fish species) and requires an action plan for accidental exposures. The present review will analyze IgE- and non-IgE-mediated fish allergy in children from epidemiology, pathogenesis to clinical features. Moreover, clinical management will be addressed with a particular focus on potential nutritional deficiencies.
Collapse
Affiliation(s)
- Carla Mastrorilli
- Admission and Emergency Pediatric Medicine and Surgery Unit, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy; (C.M.); (M.G.)
| | - Stefania Arasi
- Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Simona Barni
- Allergic Unit, Department of Pediatric, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France;
- IDESP, UMR A11, Université de Montpellier, 34093 Montpellier, France
| | - Fernanda Chiera
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Giulio Dinardo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.M.D.G.)
| | - Arianna Giannetti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Marco Gismondi
- Admission and Emergency Pediatric Medicine and Surgery Unit, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy; (C.M.); (M.G.)
| | - Serena Gracci
- Pediatrics and Neonatology Complex Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, 50053 Empoli, Italy;
- Department of Pediatrics, University Hospital of Pisa, 56124 Pisa, Italy
| | - Francesco Paravati
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Umberto Pelosi
- Pediatric Unit, Santa Barbara Hospital, 09016 Iglesias, Italy;
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.M.D.G.)
| | - Roberto Bernardini
- Pediatrics and Neonatology Complex Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, 50053 Empoli, Italy;
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy;
| |
Collapse
|
12
|
Hartono S, Zidan E, Sitaula P, Brooks JP. Pearls and pitfalls in food protein-induced enterocolitis syndrome (FPIES). Allergy Asthma Proc 2023; 44:368-373. [PMID: 37641223 PMCID: PMC10629436 DOI: 10.2500/aap.2023.44.230047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background: Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-immunoglobulin E (IgE) mediated gastrointestinal food hypersensitivity. It is a clinical diagnosis commonly characterized by profuse vomiting 1 to 4 hours after ingestion of the triggering food(s). Objective: The objective was to increase awareness of FPIES and review the epidemiology, clinical presentation, pathogenesis, diagnosis, and management of FPIES. The lack of availability of a definite biomarker or diagnostic tool often leads to a delay in diagnosis. Methods: A literature search of salient articles that described case reports and case series of FPIES and their management were analyzed. Results: A case of FPIES with a literature review is presented with emphasis on clinical pearls and pitfalls. FPIES is a diagnosis of exclusion and the mainstay of treatment is avoidance of the trigger food(s) for at least 12-18 months from the last exposure. Conclusion: As FPIES is a non-IgE-mediated reaction, allergy testing via skin-prick test or blood tests to measure food IgE antibodies is not routinely recommended. Many children outgrow FPIES by 3-4 years of age. Supervised oral food challenge is recommended to assess acquisition of tolerance.
Collapse
Affiliation(s)
- Stella Hartono
- From the Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Elena Zidan
- Department of Internal Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, Connecticut, and
| | - Prasiksha Sitaula
- Division of Pediatric Allergy, Immunology, and Rheumatology, Columbia University Irving Medical Center, New York, New York
| | - Joel P Brooks
- Division of Pediatric Allergy, Immunology, and Rheumatology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
13
|
Zhu WZ, Perkins S. A case report of acute food protein-induced enterocolitis syndrome to walnut. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:57. [PMID: 37393294 DOI: 10.1186/s13223-023-00812-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a delayed, non-IgE-mediated food allergy. This syndrome was once thought to be rare, but emerging literature suggests an increasing incidence along with more foods being implicated. Also, with the introduction of guidelines on early peanut introduction, peanut-induced FPIES seems to be increasing in Australia and USA. Although most patients are diagnosed with FPIES within the first year of life, most commonly with food triggers to cow's milk or soy, other phenotypes exist in comparison to this classic presentation. In this case report, we present a patient with late onset of acute FPIES at age 3 to walnut. CASE PRESENTATION We describe a case of FPIES in a 12-year-old boy who had recurrent episodes of repetitive emesis, that began at age 3, each time after consuming walnuts. Mom does not give a history of intentional feeding (or avoidance) of walnut and/ or pecans. She also described possible reactions with pine nuts and macadamia. He was assessed with an oral food challenge to walnut, which triggered an episode of acute FPIES. He developed vomiting with onset 2 h post-ingestion, pallor, lethargy, and required an emergency department visit for anti-emetic medications and oral rehydration therapy. He improved on the therapy and now avoids cashew, pistachio, hazelnuts, walnuts, pecans, pine nuts, and macadamia nuts. CONCLUSIONS This case report adds to the limited literature that exists on culprit food allergens in FPIES. We present an acute FPIES triggered by the ingestion of walnuts. The diagnosis, common food triggers, and natural history of FPIES are described. There remains a lack of information on the natural history of FPIES, especially towards uncommon food triggers and on FPIES that present beyond infancy.
Collapse
Affiliation(s)
- Wen Zheng Zhu
- Doctor of Medicine undergraduate medical program, University of British Columbia, Vancouver, Canada
| | - Siobhan Perkins
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Division of Allergy and Immunology, Department of Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
14
|
Novembre E, Giovannini M, Catamerò F, Liccioli G, Sarti L, Barni S, Mori F. Acute FPIES and DIES: is a G lacking? Front Pediatr 2023; 11:1185196. [PMID: 37408982 PMCID: PMC10318171 DOI: 10.3389/fped.2023.1185196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- Elio Novembre
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy
- Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesco Catamerò
- Department of Health Sciences, University of Florence, Florence, Italy
- Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Giulia Liccioli
- Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
| |
Collapse
|
15
|
Su KW, Cetinbas M, Martin VM, Virkud YV, Seay H, Ndahayo R, Rosow R, Elkort M, Gupta B, Kramer E, Pronchick T, Reuter S, Sadreyev RI, Huang JL, Shreffler WG, Yuan Q. Early infancy dysbiosis in food protein-induced enterocolitis syndrome: A prospective cohort study. Allergy 2023; 78:1595-1604. [PMID: 36635218 PMCID: PMC10534226 DOI: 10.1111/all.15644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The microbiome associations of food protein-induced enterocolitis syndrome (FPIES) are understudied. We sought to prospectively define the clinical features of FPIES in a birth cohort, and investigate for the evidence of gut dysbiosis. METHODS We identified children diagnosed with FPIES in the Gastrointestinal Microbiome and Allergic Proctocolitis Study, a healthy infant cohort. Children were assessed and stools were collected at each well child visit. The clinical features of the children with FPIES were summarized. Stool microbiome was analyzed using 16S rRNA sequencing comparing children with and without FPIES. RESULTS Of the 874 children followed up for 3 years, 8 FPIES cases (4 male) were identified, yielding a cumulative incidence of 0.92%. The most common triggers were oat and rice (n = 3, each) followed by milk (n = 2). The children with FPIES were more likely to have family history of food allergy (50% vs. 15.9% among unaffected, p = .03). The average age of disease presentation was 6 months old. During the first 6 months of life, stool from children with FPIES contained significantly less Bifidobacterium adolescentis, but more pathobionts, including Bacteroides spp. (especially Bacteroides fragilis), Holdemania spp., Lachnobacterium spp., and Acinetobacter lwoffii. The short-chain fatty acid (SCFA)-producing Bifidobacterium shunt was expressed significantly less in the stool from FPIES children. CONCLUSIONS In this cohort, the cumulative incidence over the 3-year study period was 0.92%. During the first 6 months of life, children with FPIES had evidence of dysbiosis and SCFA production pathway was expressed less in their stool, which may play an important role in the pathogenesis of FPIES.
Collapse
Affiliation(s)
- Kuan-Wen Su
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Murat Cetinbas
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria M. Martin
- Harvard Medical School, Boston, Massachusetts, USA
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yamini V. Virkud
- Department of Pediatrics, School of Medicine, University of North Carolina, North Carolina, USA
| | - Hannah Seay
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Renata Ndahayo
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachael Rosow
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Elkort
- Harvard Medical School, Boston, Massachusetts, USA
- Pediatrics at Newton Wellesley, P.C., Newton, Massachusetts, USA
| | - Brinda Gupta
- Pediatrics at Newton Wellesley, P.C., Newton, Massachusetts, USA
| | - Eileen Kramer
- Pediatrics at Newton Wellesley, P.C., Newton, Massachusetts, USA
| | | | - Susan Reuter
- Pediatrics at Newton Wellesley, P.C., Newton, Massachusetts, USA
| | - Ruslan I. Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan
| | - Wayne G. Shreffler
- Harvard Medical School, Boston, Massachusetts, USA
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Qian Yuan
- Harvard Medical School, Boston, Massachusetts, USA
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Massachusetts General Hospital, Boston, Massachusetts, USA
- Pediatrics at Newton Wellesley, P.C., Newton, Massachusetts, USA
| |
Collapse
|
16
|
Vazquez-Ortiz M, Khaleva E, Mukherjee S, Infante S, Meyer J, LeFew A, Yuan Q, Martinon-Torres F, Knibb RC. Challenges and unmet needs in FPIES from the parents and adult patients' perspective: An international survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1306-1309.e2. [PMID: 36581071 DOI: 10.1016/j.jaip.2022.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/23/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Ekaterina Khaleva
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Shubhasree Mukherjee
- Paediatrics Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sonsoles Infante
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Joy Meyer
- The FPIES Foundation, Stewartville, Minn
| | | | - Qian Yuan
- Food Allergy Center, Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rebecca C Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| |
Collapse
|
17
|
Bel Imam M, Stikas CV, Guha P, Chawes BL, Chu D, Greenhawt M, Khaleva E, Munblit D, Nekliudov N, van de Veen W, Schoos AMM. Outcomes reported in randomized controlled trials for mixed and non-IgE-mediated food allergy: Systematic review. Clin Exp Allergy 2023; 53:526-535. [PMID: 36880564 DOI: 10.1111/cea.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Mixed and non-IgE-mediated food allergy is a subset of immune-mediated adverse food reactions that can impose a major burden on the quality of life of affected patients and their families. Clinical trials to study these diseases are reliant upon consistent and valid outcome measures that are relevant to both patients and clinicians, but the degree to which such stringent outcome reporting takes place is poorly studied. OBJECTIVE As part of the Core Outcome Measures for Food Allergy (COMFA) project, we identified outcomes reported in randomized clinical trials (RCT) of treatments for mixed or non-IgE-mediated food allergy. DESIGN In this systematic review, we searched the Ovid, MEDLINE and Embase databases for RCTs in children or adults investigating treatments for food protein-induced enterocolitis syndrome, food protein-induced allergic proctocolitis, food protein-induced enteropathy and eosinophilic gastrointestinal disorders including eosinophilic esophagitis [EoE], eosinophilic gastritis and eosinophilic colitis published until 14 October 2022. RESULTS Twenty-six eligible studies were identified, with 23 focused on EoE (88%). Most interventions were corticosteroids or monoclonal antibodies. All EoE studies assessed patient-reported dysphagia, usually using a non-validated questionnaire. Twenty-two of 23 EoE studies used peak tissue eosinophil count as the primary outcome, usually using a non-validated assessment method, and other immunological markers were only exploratory. Thirteen (57%) EoE studies reported endoscopic outcomes of which six used a validated scoring tool recently recommended as a core outcome for EoE trials. Funding source was not obviously associated with likelihood of an RCT reporting mechanistic versus patient-reported outcomes. Only 3 (12%) RCTs concerned forms of food allergy other than EoE, and they reported on fecal immunological markers and patient-reported outcomes. CONCLUSIONS Outcomes measured in clinical trials of EoE and non-IgE-mediated food allergy are heterogeneous and largely non-validated. Core outcomes for EoE have been developed and need to be used in future trials. For other forms of mixed or non-IgE-mediated food allergies, core outcome development is needed to support the development of effective treatments. SYSTEMATIC REVIEW REGISTRATION OSF public registry DOI:10.17605/OSF.IO/AZX8S.
Collapse
Affiliation(s)
- Manal Bel Imam
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | | | - Payal Guha
- School of Medicine, Imperial College London, London, UK
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Derek Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,The Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Ekaterina Khaleva
- Clinical and Experimental Sciences and Human Development, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Inflammation, Repair and Development Section, NHLI, Imperial College London, London, UK
| | - Nikita Nekliudov
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ann-Marie M Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | | |
Collapse
|
18
|
Taştan GS, Arslan Z. Development of Acute FPIES Following FPIAP in a Breastfed Infant. Clin Pediatr (Phila) 2023; 62:177-179. [PMID: 35993238 DOI: 10.1177/00099228221113710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gökçe Su Taştan
- TOBB University of Economics and Technology Faculty of Medicine, Ankara, Turkey
| | - Zafer Arslan
- TOBB University of Economics and Technology Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| |
Collapse
|
19
|
AL-Iede M, Sarhan L, Alshrouf MA, Said Y. Perspectives on Non-IgE-Mediated Gastrointestinal Food Allergy in Pediatrics: A Review of Current Evidence and Guidelines. J Asthma Allergy 2023; 16:279-291. [PMID: 36942164 PMCID: PMC10024490 DOI: 10.2147/jaa.s284825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/17/2023] [Indexed: 03/15/2023] Open
Abstract
Food allergy is an immune-mediated disease that can result in considerable morbidity and even mortality, with a significant negative impact on patients' quality of life. It is characterized by allergic symptoms that can occur shortly after a relevant food allergen ingestion, or can be delayed or chronic, which make it more difficult for diagnosis. The symptoms of this disease can range from mild to severe, and rarely can cause anaphylaxis, a life-threatening allergic reaction. The prevalence of non-immunoglobulin E (IgE)-mediated food allergy is poorly established outside of cow's milk allergy, with an adjusted incidence ranging between 0.13% and 0.72%. Several disorders are classified as non-immunoglobulin E (IgE)-mediated food allergies that predominantly affect the gastrointestinal tract including food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), food protein-induced allergic enteropathy (FPE), and food protein-induced dysmotility disorders (GORD and constipation). Eosinophilic esophagitis (EoE) is listed in this group, even though it considered by some authorities to be mixed reaction with both IgE and cell-mediated immune response to be involved in the reaction. The most common types of non-IgE-mediated food allergy are food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). These disorders typically present in infancy and are often triggered by cow's milk protein. Patients with FPIES present with profuse emesis and dehydration, while FPIAP patients present with hematochezia in otherwise healthy infants. Since there are no specific confirmatory non-invasive diagnostic laboratory tests, the diagnosis is usually made clinically when typical symptoms improve upon the removal of the culprit food. Food reintroduction should be attempted, when possible, with documentation of symptoms of relapse to confirm the diagnosis. The management includes dietary avoidance, supportive treatment in the case of accidental exposure, and nutritional counseling. This review focuses on the clinical manifestations, epidemiology, management, and recent guidelines of the most common non-IgE-mediated food hypersensitivity disorders (FPIES, FPIAP, and FPE).
Collapse
Affiliation(s)
- Montaha AL-Iede
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Jordan University Hospital, Amman, Jordan
- Correspondence: Montaha AL-Iede, Division of Pediatric Pulmonology and Sleep Medicine, The University of Jordan, Queen Rania Street, Amman, 11972, Jordan, Tel + 962 65355000, Email ;
| | - Lena Sarhan
- Department of Pediatrics, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad A Alshrouf
- Department of Pediatrics, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan
| | - Yazan Said
- Division of Allergy, Immunology, and pulmonology, Department of Pediatrics, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| |
Collapse
|
20
|
Ohnishi S, Yamamoto-Hanada K, Sato M, Uematsu S, Ohya Y. Food protein-induced enterocolitis syndrome is an important differential diagnosis of vomiting in pediatric emergency. Pediatr Int 2023; 65:e15675. [PMID: 38088527 DOI: 10.1111/ped.15675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The aim of this study was to clarify the clinical characteristics and management of infants with suspected acute food protein-induced enterocolitis syndrome (FPIES) who presented to the pediatric emergency department (ED) before and after the guidelines were published. METHODS This was a retrospective cohort study. We classified the infants as "acute FPIES-like symptoms" who were younger than 12 months of age and visited the pediatric ED of the National Center for Child Health and Development due to vomiting 1-4 h after food ingestion without any causative disease, such as infection. The medical records of those infants in 2015 and 2021 were reviewed. We used the nonparametric Mann-Whitney U test to compare two groups for continuous variables, whereas chi-squared or Fisher's exact tests were used for nominal variables. RESULTS The number of infants with acute FPIES-like symptoms was 15 (13%) in 2015 and 14 (15%) in 2021. The trigger foods were cow's milk or dairy products in half of the infants, and five as a result of ingestion of hen's eggs in 2021, compared to zero cases in 2015. Five in 2015 and 12 in 2021 required examination at the ED. Three in 2015 and six in 2021 met the diagnostic criteria for acute FPIES in the international consensus guidelines. The emergency physicians did not record at least four minor criteria for acute FPIES in seven in 2015 and five in 2021. No infants (0%) in 2015 and two (14%) in 2021 were referred to the allergy department by an emergency physician. CONCLUSIONS Acute FPIES should be considered one of the differential diagnoses of vomiting, and pediatric medical staff should be aware of FPIES diagnostic criteria and appropriately refer suspected cases to a specialist.
Collapse
Affiliation(s)
- Shima Ohnishi
- Department of Pediatric Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Satoko Uematsu
- Department of Pediatric Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
21
|
Bair E. Introduction of soy-free plant-based pediatric formula in infants with FPIES: A case report. Nutr Health 2022:2601060221138849. [PMID: 36445066 DOI: 10.1177/02601060221138849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Standard practice for management of food protein-induced enterocolitis syndrome (FPIES) frequently requires the use of hypoallergenic semi-elemental or elemental formulas. For some patients, there is poor tolerance of these formulas and no improvement of gastrointestinal symptoms. For others, especially those over 4 months of age, the introduction of these formulas is difficult due to their scientifically demonstrated poor palatability. Case presentation: This case report features an 18-month-old child diagnosed with FPIES at 4 months who failed to tolerate standard hypoallergenic semi-elemental and elemental formulas to supplement maternal breast milk feedings resulting in suboptimal growth. After failing to tolerate all standard options, the patient was introduced off-label to a plant-based pediatric formula, Else Toddler, at 6 months-of-age. Outcomes and implications: In this case, Else Toddler was tolerated as a source of supplemental nutrition without triggering FPIES symptoms. Recommendations: This case demonstrates the successful use of Else Toddler, a pediatric formula sourced from almond butter, buckwheat flour, and tapioca maltodextrin, as a possible alternative to the standard use of hydrolysate or elemental amino-acid formulas. It is free of some of the most common FPIES triggers - dairy, soy, rice, and pea proteins and there for a possible acceptable alternative approach to FPIES management.
Collapse
Affiliation(s)
- Emily Bair
- Pediatric Gastroenterology, 21614University of Michigan Medicine, Ann Arbor, MI, USA
| |
Collapse
|
22
|
Hernández‐Almeida P, Vásconez‐Muñoz F, Vásconez‐Montalvo A, Sempértegui‐Moscoso R, Contreras G, Carrión‐Jaramillo E. Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review. Clin Case Rep 2022; 10:e6520. [DOI: 10.1002/ccr3.6520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/25/2022] [Accepted: 10/09/2022] [Indexed: 11/25/2022] Open
|
23
|
Mathew M, Leeds S, Nowak-Węgrzyn A. Recent Update in Food Protein-Induced Enterocolitis Syndrome: Pathophysiology, Diagnosis, and Management. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:587-603. [PMID: 36426394 PMCID: PMC9709682 DOI: 10.4168/aair.2022.14.6.587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES), though first reported in the 1970s, remains poorly understood and likely underdiagnosed. It is a non-immunoglobulin E (IgE)-mediated food allergy syndrome, most commonly identified in infancy and childhood. It can manifest as a constellation of symptoms following food ingestion, including repetitive and projectile emesis (1-4 hours), accompanied by pallor, lethargy, muscular hypotonia, and diarrhea (5-10 hours). In more severe reactions, significant leukocytosis with neutrophilia, thrombocytosis, metabolic derangements, methemoglobinemia, anemia, low albumin, and total protein may be present. Hypotension and ultimately hypovolemic distributive shock may occur in up to 15%-20% of cases. The diagnosis of FPIES is challenging and providers continue to face difficulties in management. This review article aims to highlight the most recent updates in epidemiology, natural history, pathophysiology, potential diagnostic markers, and guidelines for the management of FPIES.
Collapse
Affiliation(s)
- Mehr Mathew
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Stephanie Leeds
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Anna Nowak-Węgrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, NY, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
| |
Collapse
|
24
|
Remission of Acute Food Protein-Induced Enterocolitis Syndrome Confirmed by Oral Food Challenges in Japan. Nutrients 2022; 14:nu14194158. [PMID: 36235810 PMCID: PMC9570973 DOI: 10.3390/nu14194158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
The oral food challenge test (OFC) is the gold standard for evaluating the remission of food protein-induced enterocolitis syndrome (FPIES). Few acute FPIES remissions confirmed by OFC were reported. This study aimed to examine the OFC for Japanese children with acute FPIES to evaluate its remission. A retrospective cohort study was performed on children with acute FPIES with remission evaluation by OFC based on one food challenge dose (1/50, 1/10, 1/2, and full dose per day). Acute FPIES remission was observed in 65.2% of patients (15/23 patients). Vomiting episodes occurred with 1/50 full doses on the first day among 75% of positive patients. The median duration between the onset and OFC was 14 months (IQR, 8-24 months). Soy was the most common causative food, followed by egg yolk, milk, and wheat. All patients could receive OFC safely without intensive care unit care, based on the FPIES OFC protocol. The remission rate of acute FPIES was high. However, vomiting episodes commonly occurred with 1/50 full doses on the first day. This study suggested that our OFC protocol for acute FPIES was safe and feasible, but it might be safer for some patients to start at a minimal loading dose.
Collapse
|
25
|
Hayano S, Natsume O, Yasuoka R, Katoh Y, Koda M. Predictors of initial oral food challenge outcome in food protein-induced enterocolitis syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:122-127. [PMID: 37781265 PMCID: PMC10509941 DOI: 10.1016/j.jacig.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 10/03/2023]
Abstract
Background There is a paucity of data on predictors of clinical history in oral food challenge (OFC) outcome for the initial diagnosis of food protein-induced enterocolitis syndrome (FPIES). Objective This study aimed to identify predictors for the diagnosis of FPIES. Methods The study included patients who underwent OFC to diagnose FPIES from 2010 to 2021. Patients with a positive OFC result were classified as belonging to the FPIES group, and those with negative OFC result within 120 days from the last symptomatic episode were classified as belonging to the no-allergy (NA) group. Background factors were analyzed in the groups. Results A total of 50 OFCs to 12 different foods were conducted in 50 patients. Of those 50 patients, 30 were classified as belonging to the FPIES group. No significant difference was observed between the FPIES and NA groups with respect to background factors, including the features of symptomatic episodes and examinations of immediate-type allergy. A history of asymptomatic ingestion was observed in 23 of 24 and 13 of 19 patients in the FPIES and NA groups, respectively; thus, it was significantly more common in patients with FPIES. The diagnostic rate of patients with fewer than 3 symptomatic episodes was 52%, and that of patients with 3 episodes or more was 75%, not considering a patient without available data. Conclusions A definite diagnosis of FPIES should be based on OFC, as there are no predictors for OFC positivity other than a history of asymptomatic ingestion. The absence of asymptomatic ingestion history was a negative predictor for the diagnosis of FPIES.
Collapse
Affiliation(s)
- Satoshi Hayano
- Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan
- Department of Pediatrics, Chutoen General Medical Center, Kakegawa, Japan
| | - Osamu Natsume
- Department of Pediatrics, Chutoen General Medical Center, Kakegawa, Japan
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu City, Japan
- Department of Pediatrics, Public Morimachi Hospital, Morimachi, Japan
| | - Ryuhei Yasuoka
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| | - Yukiko Katoh
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| | - Masaki Koda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| |
Collapse
|
26
|
Poultry Meat allergy: a Review of Allergens and Clinical Phenotypes. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose of review
In the recent years, more cases of poultry meat allergy, both IgE- or non-IgE-mediated, are being reported. Patients have varied clinical reactivity at various levels of sensitivity to different meat preparations. The lack of validated biomarkers renders accurate diagnosis challenging. In this review, we aim to provide an overview of the current status of poultry meat allergy along with a description on the allergens implicated.
Recent findings
Poultry meat allergy occurs as a result of cross-reactions with known allergens of egg yolk or bird feathers or as genuine IgE-mediated sensitivity to allergens in poultry meat. Individuals can also develop non-IgE-mediated hypersensitivity reactions to poultry meat. Chicken serum albumin is the main responsible allergen in secondary cases, while myosin light chain, α parvalbumin, enolase, aldolase, hemoglobin, and α-actin have been recognized as potential eliciting allergens in genuine poultry meat allergy.
Summary
There is a wide phenotypic variation among patients with poultry meat allergy, regarding clinical severity and cross-reactivity features. Recognizing the various clinical entities of reactions to poultry meat is an important step towards accurate diagnosis and providing management options that are well received by patients.
Collapse
|
27
|
Malabsorption Syndromes and Food Intolerance. Clin Perinatol 2022; 49:537-555. [PMID: 35659102 DOI: 10.1016/j.clp.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Feeding intolerance is ubiquitous in neonatal intensive care units with as many signs and symptoms as possible diagnoses. Optimizing nutrition is paramount in both preterm and term infants. Determining the cause of feeding intolerance and adjusting nutrition interventions is an important part of the daily care of newborns. This review discusses the role of malabsorption and food intolerance as possible causes of nutrition difficulties in the newborn.
Collapse
|
28
|
Anvari S, Ruffner MA. Adult Food Protein-Induced Enterocolitis Syndrome. FRONTIERS IN ALLERGY 2022; 3:889879. [PMID: 35769585 PMCID: PMC9234874 DOI: 10.3389/falgy.2022.889879] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE, cell-mediated food allergy, commonly diagnosed in infants and young children. In recent years, new-onset adult FPIES has been recognized. The underlying pathogenic mechanism of FPIES has yet to be elucidated, thus disease-specific diagnostic biomarkers have yet to be determined and an oral food challenge (OFC) remains the gold-standard for the diagnosis. Pediatric patients with FPIES classically present with symptoms of delayed, repetitive vomiting approximately 1 to 4 hours following ingestion of a food allergen. However, adults with FPIES have been reported to have a different symptom profile and different food triggers compared to the pediatric FPIES population. The current FPIES diagnostic criteria may not be appropriate for the diagnosis of adult FPIES patients, thus an oral food challenge remains a diagnostic tool. This review provides an overview of the current literature on the clinical presentation, epidemiology, diagnosis, triggers and management of adult FPIES.
Collapse
Affiliation(s)
- Sara Anvari
- Division of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, United States
- *Correspondence: Sara Anvari
| | - Melanie A. Ruffner
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| |
Collapse
|
29
|
Baker MG, Cecilia Berin M, Sicherer S. Update on Food Protein-Induced Enterocolitis Syndrome (FPIES). Curr Allergy Asthma Rep 2022; 22:113-122. [PMID: 35522370 DOI: 10.1007/s11882-022-01037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this condition has grown. RECENT FINDINGS FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability. Management involves trigger avoidance, and patients may benefit from the support of a dietitian to ensure adequate nutrient intake. Tolerance develops over time for most children, but due to the risk of severe symptoms, re-introduction of a suspected FPIES trigger is recommended only under supervision at an oral food challenge. Studies continue to evaluate the optimal challenge protocol. Caregivers of children with FPIES report high levels of anxiety and stress, which is attributed to the dramatic symptomatology, dietary restrictions, nutritional concerns, lack of confirmatory diagnostic tests, and limited tools for management of reactions. Our understanding of the FPIES diagnosis has improved over the last few decades, but there remain opportunities, particularly regarding discerning the pathophysiology and best management practices.
Collapse
Affiliation(s)
- Mary Grace Baker
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA.
| | - M Cecilia Berin
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA
| | - Scott Sicherer
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA
| |
Collapse
|
30
|
Lange L, Gernert S, Berger M, Arens A, Rache L, Delissen J, Yavuz ST, Millner-Uhlemann M, Wiesenäcker D, Neustädter I, Reese I, Utz P, Schuster A, Adelsberger D, Ziegert M, Kerzel S, Finger A. Different Patterns of Foods Triggering FPIES in Germany. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1063-1069. [PMID: 34942384 DOI: 10.1016/j.jaip.2021.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy mainly affecting infants and young children. Allergic FPIES reactions differ from IgE-mediated food allergies, for example, regarding elicitors and clinical course. OBJECTIVE The aim of our study was to describe causative agents and development of tolerance in German children with FPIES. METHODS We conducted a retrospective survey on children with FPIES from 14 centers in Germany assessing a 6-year period. RESULTS We analyzed 142 patients with 190 FPIES reactions, 130 of which met acute FPIES criteria and 60 were defined as chronic FPIES. The most frequent eliciting food for acute FPIES was cow's milk, followed by fish, vegetables (eg, potato, pumpkin), meats (eg, beef), and grains. A total of 119 children reacted to 1 food only, 16 children to 2 or 3 foods, and 7 children to ≥4 foods. In chronic FPIES, all but 4 exclusively breastfed infants reacted to cow's milk feeding. IgE sensitization to the triggering food was found in 21 of 152 (14%) cases. Two children developed additional IgE-mediated symptoms upon a food challenge. Time to proof of tolerance was shortest in cow's milk-induced FPIES, and it was shorter in chronic than in acute FPIES. CONCLUSION In our national survey, we identified triggers for acute FPIES that partially differ from those reported internationally. Mainly foods introduced early in infant nutrition triggered acute reactions. Time to proven tolerance was shown to be contingent on FPIES symptomatology and on the triggering food. These data should be considered regarding nutritional advice for infants with FPIES.
Collapse
Affiliation(s)
- Lars Lange
- Department of Pediatrics, St. Marien-Hospital, Bonn, Germany.
| | - Sunhild Gernert
- Department of Pediatrics, St. Marien-Hospital, Bonn, Germany
| | - Moritz Berger
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alisa Arens
- Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | | | - Julia Delissen
- Department of Paediatrics, Children's Hospital Amsterdamer Straße, Cologne, Germany
| | - S Tolga Yavuz
- Department of Pediatric Allergy, Childen's Hospital, University of Bonn, Bonn, Germany
| | | | - David Wiesenäcker
- Department of Pediatrics, Kinderklinik München Schwabing, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irena Neustädter
- Department of Pediatrics and Pediatric Intensive Care, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Imke Reese
- Dietary Counseling and Nutrition Therapy Centre, Munich, Germany
| | - Philipp Utz
- Children's University Hospital, Tuebingen, Germany
| | - Antje Schuster
- Department of Paediatrics, University Hospital, Düsseldorf, Germany
| | - Deborah Adelsberger
- Department of Pediatric Pneumology and Allergology, Klinikum Oldenburg, Medical Campus of University Oldenburg, Oldenburg, Germany
| | - Mandy Ziegert
- Department of Pediatric Allergology, German Red Cross Hospital, Berlin, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
| | - Antje Finger
- Department of Pediatrics, St. Marien-Hospital, Bonn, Germany
| |
Collapse
|
31
|
Lemoine A, Colas A, Le S, Delacourt C, Tounian P, Lezmi G. Food protein‐induced enterocolitis syndrome: A large French multicentric experience. Clin Transl Allergy 2022; 12:e12112. [PMID: 35218323 PMCID: PMC8850996 DOI: 10.1002/clt2.12112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anaïs Lemoine
- Department of Pediatric Nutrition and Gastroenterology Trousseau Hospital AP‐HP Sorbonne Université Paris France
| | - Anne‐Sophie Colas
- Department of Pediatric Nutrition and Gastroenterology Trousseau Hospital AP‐HP Sorbonne Université Paris France
- Pediatric Emergency Unit Trousseau Hospital AP‐HP Paris France
| | - Sébastien Le
- Department of Pediatric Pneumology and Allergology Necker‐Enfants Malades Hospital AP‐HP Université Paris Descartes Paris France
- Department of Pediatric and Emergency Unit Louis Mourier Hospital AP‐HP Université de Paris Paris France
| | - Christophe Delacourt
- Department of Pediatric Pneumology and Allergology Necker‐Enfants Malades Hospital AP‐HP Université Paris Descartes Paris France
| | - Patrick Tounian
- Department of Pediatric Nutrition and Gastroenterology Trousseau Hospital AP‐HP Sorbonne Université Paris France
| | - Guillaume Lezmi
- Department of Pediatric Pneumology and Allergology Necker‐Enfants Malades Hospital AP‐HP Université Paris Descartes Paris France
| |
Collapse
|
32
|
Stiefel G, Alviani C, Afzal NA, Byrne A, du Toit G, DunnGalvin A, Hourihane J, Jay N, Michaelis LJ, Erlewyn-Lajeunesse M. Food protein-induced enterocolitis syndrome in the British Isles. Arch Dis Child 2022; 107:123-127. [PMID: 34446441 DOI: 10.1136/archdischild-2020-320924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a delayed type of food allergy, most often seen in infancy. We aimed to estimate its incidence, to describe common food triggers and the patient journeys of this rare but serious condition. DESIGN We undertook a prospective epidemiological survey of FPIES using the British Paediatric Surveillance Unit. SETTING UK and Ireland. PARTICIPANTS A survey of all paediatricians over 13 months between January 2019 and February 2020. MAIN OUTCOME MEASURES 204 cases were reported, 98 (48%) meeting case definition, giving an incidence of 0.006% for England based on 93 cases. RESULTS 98 patients reported 135 trigger foods, 27% (26 of 98) had multiple food triggers. Common food triggers included cow's milk (24%, 33 of 135), fruits and vegetables (19%, 26 of 135), hen's egg (16%, 22 of 135) and fish (14%, 19 of 135). In 46% (41 of 90), the initial trigger food had been ingested three or more times before diagnosis, with a median diagnostic delay of 7.9 months (3.0, 17.3). Half (50 of 98) were admitted, yet only 5% (5 of 98) received appropriate acute treatment with ondansetron. Most cases were diagnosed by an allergy specialist (74 of 98, 76%), within a median of 7.5 (3.0, 13.3) miles from home. CONCLUSION The incidence of FPIES was significantly lower than expected across the whole of the British Isles. Most reports were of cases local to specialist allergy centres, with delays in diagnosis. This suggests under-recognition of FPIES in frontline clinical setting where education of healthcare professionals is required to improve recognition, earlier diagnosis and treatment.
Collapse
Affiliation(s)
- Gary Stiefel
- Paediatric Allergy, Leicester Children's Hospital, Leicester, UK
| | - Cherry Alviani
- Paediatric Allergy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nadeem A Afzal
- Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - George du Toit
- Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Jonathan Hourihane
- Children's Health Ireland, Dublin, Ireland.,Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nicola Jay
- Paediatric Allergy, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Louise Jane Michaelis
- Paediatric Immunology and Allergy, Great North Children's Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | |
Collapse
|
33
|
Campbell DE, Turner PJ. Food protein enterocolitis syndrome: underdiagnosed, not treated optimally. Arch Dis Child 2022; 107:105-106. [PMID: 34794941 DOI: 10.1136/archdischild-2021-323152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Dianne E Campbell
- Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul J Turner
- Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia .,National Heart & Lung Institute, Imperial College London, London, UK
| |
Collapse
|
34
|
Zhang S, Sicherer S, Berin MC, Agyemang A. Pathophysiology of Non-IgE-Mediated Food Allergy. Immunotargets Ther 2022; 10:431-446. [PMID: 35004389 PMCID: PMC8721028 DOI: 10.2147/itt.s284821] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
Non-IgE-mediated food allergies are a group of disorders characterized by subacute or chronic inflammatory processes in the gut. Unlike IgE mediated food allergies that may result in multi-organ system anaphylaxis, the non-IgE mediated food allergies primarily affect the gastrointestinal tract. This review outlines the clinical manifestations, epidemiology, pathophysiology, and management of non-IgE-mediated food allergies. An updated literature search of selected non-IgE-mediated food allergies was conducted for this review using PubMed database to the current year (2021). Reviewed disorders include food protein-induced enterocolitis syndrome (FPIES), food-protein enteropathy (FPE), food protein-induced allergic proctocolitis (FPIAP), and eosinophilic gastrointestinal disorders (EGIDs) such as eosinophilic esophagitis (EoE). While extensive gains have been made in understanding FPIES, FPIAP, FPE, and EoE, more information is needed on the pathophysiology of these food allergies. Similarities among them include involvement of innate immunity, T-lymphocyte processes, alteration of the intestinal lumen at the cellular level with the appearance of inflammatory cells and associated histologic changes, and specific cytokine profiles suggesting food-specific, T-cell, and immune-mediated responses. While FPIES and FPIAP typically resolve in early childhood, EGIDs typically do not. Emerging new therapies for EoE offer promise of additional treatment options. Further studies identifying the immunopathogenesis, associated biomarkers, and mechanisms of tolerance are needed to inform prevention, diagnosis and management.
Collapse
Affiliation(s)
- Shouling Zhang
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY, USA
| | - Scott Sicherer
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY, USA
| | - M Cecilia Berin
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY, USA
| | - Amanda Agyemang
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY, USA
| |
Collapse
|
35
|
Venter C, Meyer R, Ebisawa M, Athanasopoulou P, Mack DP. Food allergen ladders: A need for standardization. Pediatr Allergy Immunol 2022; 33:e13714. [PMID: 34882843 DOI: 10.1111/pai.13714] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The process of gradually reintroducing food allergens into an individual's diet is referred to as food allergen "ladders". There remain many questions regarding the foods chosen, structure and composition of the ladder, and medical and safety considerations. The COVID-19 pandemic has propelled us into an era where medicine is increasingly practiced via online platforms, highlighting the need for standardized food allergen ladder approaches for successful and safe introduction of food allergens. METHODS We performed a search of currently published food allergen ladders and obtained published information and clinical expertise to summarize current knowledge and suggest future standardized approaches for using food allergen ladders. RESULTS There are currently a limited number of published milk, egg, wheat, and soy ladders. We suggest the following points should be considered when developing food ladders: (1) Food allergen: dose, time, and temperature of heating of the food allergen, simplicity of the ladder and recipes, the possible role of the wheat matrix, and testing for allergenic protein levels to standardize doses; (2) Nutritional factors: health and nutritional value of the foods in the ladder, taste, texture, and cultural appropriateness of foods should be considered; and (3) Medical aspects: consideration of which patients are safe to undergo ladders outside of the clinical setting, other safety aspects and risk factors for severe reactions, number of days suggested per steps, and availability and provision of rescue medication. Written instructions and recipes should be provided to families who wish to use food allergen ladders. DISCUSSION Food allergen ladders used for gradual reintroduction of food allergens into a food allergic individual's diet are increasingly being used internationally. Standardization regarding the foods included in the ladder and medical considerations are required to practice patient-centered care, best assist patients and families, and ensure safety.
Collapse
Affiliation(s)
- Carina Venter
- Children's Hospital Colorado, University of Colorado, AuRoRa, Colorado, USA
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | | | - Douglas Paul Mack
- Department of Paediatrics, Paediatric Allergy, Asthma, and Immunology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
36
|
Tagami K, Tano C, Nakata J, Kobayashi T, Kawabe T. Egg yolk consumption history and food protein-induced enterocolitis syndrome. Pediatr Int 2022; 64:e15348. [PMID: 36410716 DOI: 10.1111/ped.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Kazunori Tagami
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai-city, Aichi, Japan
| | - Chihiro Tano
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai-city, Aichi, Japan
| | - Joon Nakata
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai-city, Aichi, Japan
| | - Takae Kobayashi
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai-city, Aichi, Japan
| | - Takashi Kawabe
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai-city, Aichi, Japan
| |
Collapse
|
37
|
Feketea G, Vassilopoulou E, Geropanta F, Berghea EC, Bocsan IC. Alternative Fish Species for Nutritional Management of Children with Fish-FPIES—A Clinical Approach. Nutrients 2021; 14:nu14010019. [PMID: 35010894 PMCID: PMC8746553 DOI: 10.3390/nu14010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/25/2022] Open
Abstract
In the Mediterranean region, fish is a common cause of food protein-induced enterocolitis syndrome (FPIES) in children. No laboratory tests specific to FPIES are available, and oral food challenge (OFC) is the gold standard for its diagnosis and testing for achievement of tolerance. Children with FPIES to fish are usually advised to avoid all fish, regardless of the species. Fish are typically classified into bony and cartilaginous, which are phylogenetically distant species and therefore contain less cross-reacting allergens. The protein β-parvalbumin, considered a pan-allergenic, is found in bony fish, while the non-allergenic α-parvalbumin is commonly found in cartilaginous fish. Based on this difference, as a first step in the therapeutic process of children with FPIES caused by a certain fish in the bony fish category (i.e., hake, cod, perch, sardine, gilthead sea bream, red mullet, sole, megrim, sea bass, anchovy, tuna, swordfish, trout, etc.), an OFC to an alternative from the category of cartilaginous fish is suggested (i.e., blue shark, tope shark, dogfish, monkfish, skate, and ray) and vice versa. Regarding the increased mercury content in some sharks and other large species, the maximum limit imposed by the European Food Safety Authority (EFSA) for weekly mercury intake must be considered. An algorithm for the management of fish-FPIES, including alternative fish species, is proposed.
Collapse
Affiliation(s)
- Gavriela Feketea
- PhD School, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
- Department of Pediatrics, Amaliada Hospital, 27200 Amaliada, Greece
- Department of Pediatrics, Karamandaneio Children’s Hospital, 26331 Patras, Greece
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece;
| | | | - Elena Camelia Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatrics, “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
- Correspondence:
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| |
Collapse
|
38
|
Boyer J, Sgambelluri L, Yuan Q. Association of Antibiotic Usage with Food Protein-Induced Enterocolitis Syndrome Development from a Caregiver's Survey. JPGN REPORTS 2021; 2:e132. [PMID: 35373193 PMCID: PMC8966620 DOI: 10.1097/pg9.0000000000000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/28/2021] [Indexed: 05/20/2023]
Abstract
Background Food protein-induced enterocolitis syndrome (FPIES) is a frequently misdiagnosed, serious, non-IgE mediated food allergy, and the precise mechanism of disease is unknown. Acute FPIES typically presents with repetitive, profuse vomiting approximately 1-4 hours post ingestion of a food trigger. Chronic FPIES is considered less common and less well characterized. Objective We aimed to better describe FPIES and identify factors that may influence FPIES development through use of a self-reported, caregiver's survey. Methods FPIES and allergy-free infant caregivers completed a survey regarding lifestyle factors that may influence allergy acquisition such as: antibiotic usage and delivery mode. FPIES caregivers reported symptoms, number of food triggers, type of FPIES, and symptoms from breastmilk ingestion. FPIES infants were compared to allergy-free infants to identify factors potentially associated with FPIES. Results Infant and prenatal maternal antibiotic usage was higher in FPIES infants compared to allergy-free infants (43.8% vs 20.6% and 48.8% vs 23.57%, respectively, p< 0.05). When compared to infants with ACUTE FPIES alone, infants described as BOTH acute and chronic FPIES reported earlier onset of symptoms, more non-specific symptoms and symptoms triggered by breast milk, more antibiotic exposure, and more food triggers (p< 0.05). Conclusion Antibiotic usage was significantly higher in FPIES infants when compared to allergy-free infants. Work is needed to elucidate the role of antibiotic usage in the etiology of FPIES. Infants reported to have BOTH acute and chronic FPIES were significantly different from infants with ACUTE FPIES alone highlighting the need to more closely examine these different subtypes of FPIES.
Collapse
Affiliation(s)
| | | | - Qian Yuan
- MassGeneral Hospital for Children, Boston, MA
| |
Collapse
|
39
|
Vandenplas Y, Brough HA, Fiocchi A, Miqdady M, Munasir Z, Salvatore S, Thapar N, Venter C, Vieira MC, Meyer R. Current Guidelines and Future Strategies for the Management of Cow's Milk Allergy. J Asthma Allergy 2021; 14:1243-1256. [PMID: 34712052 PMCID: PMC8548055 DOI: 10.2147/jaa.s276992] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022] Open
Abstract
Abstract Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet and the therapeutic diet is a CM based extensive hydrolysate. CM-based partial hydrolysates cannot be recommended in the management of CMA because of insufficient efficacy and possible reactions, but about half of the infants with CMA may tolerate a partial hydrolysate. The pros and cons of other dietary options are discussed in this paper. The use of an amino acid-based formula and/or rice based hydrolysate formula during the diagnostic elimination and therapeutic diet is debated. When available, there is sufficient evidence to consider rice hydrolysates as an adequate alternative to CM-based hydrolysates, since some infants will still react to the CM hydrolysate. The pros and cons of dietary options such as soy formula, buckwheat, almond, pea or other plant based dietary products are discussed. Although the majority of the plant-based beverages are nutritionally inadequate, some are nutritionally adapted for toddlers. However, accessibility and content vary by country and, thus far there is insufficient evidence on the efficacy and tolerance of these plant-based drinks (except for soy formula and rice hydrolysates) to provide an opinion on them. Conclusion A diagnostic elimination diet, followed by a challenge remains the diagnostic standard. The use of an awareness tool may result in a decrease of delayed diagnosis. Breastmilk remains the ideal source of nutrition and when not available a CM extensively hydrolyzed formula, rice hydrolysate or amino acid formula should be recommended. More evidence is needed regarding plant-based drinks.
Collapse
Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Helen A Brough
- Department Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, Rome, Italy
| | - Mohamad Miqdady
- Department of Pediatrics, Sheikh Khalifa Medical City, College of Medicine & Health Sciences, Khalifa University, Khalifa, United Arab Emirates
| | - Zakiudin Munasir
- Department of Child Health, Ciptomangunkusumo Hospital-Medical Faculty Universitas Indonesia, Jakarta, Indonesia
| | - Silvia Salvatore
- Pediatric Department, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Carina Venter
- University of Colorado, Children's Hospital Colorado, Denver, CO, USA
| | - Mario C Vieira
- Center for Pediatric Gastroenterology -Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK.,Department Nutrition and Dietetics, University of Winchester, Winchester, UK
| |
Collapse
|
40
|
IL-27 as a potential biomarker for distinguishing between necrotising enterocolitis and highly suspected early-onset food protein-induced enterocolitis syndrome with abdominal gas signs. EBioMedicine 2021; 72:103607. [PMID: 34628355 PMCID: PMC8511805 DOI: 10.1016/j.ebiom.2021.103607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background The initial clinical manifestations and abdominal imaging findings of neonates with necrotising enterocolitis (NEC) and food protein-induced enterocolitis syndrome (FPIES) are sometimes similar; however, their prognosis and therapies are different. We aimed to evaluate the utility of interleukin (IL)-27 as a differentiation marker between NEC and highly suspected early onset (HSEO)-FPIES. Methods All samples used in this study were obtained from the neonatal diagnosis centre of Children's Hospital of Chongqing Medical University. In the case-control study, neonates with NEC (n = 13), HSEO-FPIES (n = 9), and jaundice (control, n = 8) were enroled to determine the serum IL-27 levels using commercial enzyme-linked immunosorbent assay (ELISA) kits. In the validation cohort study, the NEC (n = 87), HSEO-FPIES (n = 62), and jaundice (control, n = 54) groups were included to analyse the diagnostic efficiency of IL-27 for discriminating between NEC and HSEO-FPIES using a receiver operating characteristic (ROC) curve. Findings In the case-control study, IL-27 levels were higher in the NEC group than in the HSEO-FPIES group (p = 0·005). In the cohort study, the area under the ROC curve (AUC) of IL-27 for differentiating NEC from HSEO-FPIES was 0·878, which was higher than the AUCs of IL-6 (0·761), C-reactive protein (0·800), white blood cell count (0·637), neutrophils (0·765), lymphocytes (0·782), neutrophil to lymphocyte ratio (0·781), and platelet count (0·729). Interpretation Serum IL-27 is a novel biomarker that may potentially discriminate NEC from HSEO-FPIES in neonates.
Collapse
|
41
|
Mori F, Liccioli G, Fuchs O, Barni S, Giovannini M, Sarti L, Novembre E, Caubet JC. Drug-induced enterocolitis syndrome: Similarities and differences compared with food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol 2021; 32:1165-1172. [PMID: 33651420 DOI: 10.1111/pai.13491] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
In 2014, drug-induced enterocolitis syndrome (DIES) was described for the first time. It is still a poorly known disease with symptoms that typically resemble those of food protein-induced enterocolitis syndrome (FPIES). To date, six more cases of DIES have been described and new clinical diagnostic criteria have been proposed based on those in the international guidelines for FPIES. In this paper, the authors describe three more cases of DIES. In addition, similarities and differences with FPIES have been deeply analyzed. To date, several unanswered questions need to be addressed, but clinicians must be instructed how to identify DIES, in order to make an allergy workup and give definite therapeutic indications to patients, especially in children where DIES seems to be more frequent.
Collapse
Affiliation(s)
- Francesca Mori
- Department of Paediatric Medicine, Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Giulia Liccioli
- Department of Paediatric Medicine, Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Oliver Fuchs
- Division of Pediatric Allergology and Pulmonology, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Simona Barni
- Department of Paediatric Medicine, Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Mattia Giovannini
- Department of Paediatric Medicine, Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Lucrezia Sarti
- Department of Paediatric Medicine, Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Elio Novembre
- Department of Paediatric Medicine, Allergy Unit, Meyer Children's Hospital, Florence, Italy
| | - Jean-Christoph Caubet
- Department of the Child and Adolescent, Pediatric Allergy Units, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
42
|
Ocak M, Akarsu A, Sahiner UM, Soyer O, Sekerel BE. Food protein-induced enterocolitis syndrome: Current practices in oral food challenge. Allergy Asthma Proc 2021; 42:343-349. [PMID: 34187626 DOI: 10.2500/aap.2021.42.210042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Oral food challenges (OFC) in food protein-induced enterocolitis syndrome (FPIES) are performed to confirm a diagnosis, test for development of tolerance, and find safe alternatives. Objective: We aimed to define OFC outcomes and identify safer test strategies. Methods: OFCs performed in children with FPIES over a 5-year period were reviewed. Results: A total of 160 OFCs were performed in 59 children (median age, 2.3 years). The most commonly tested foods were hen's egg, fish, and cow's milk. Sixty-six OFC results (41.3%) were positive. Twelve (18.2%) reactions were mild, 18 (27.3%) were moderate, and 36 (54.5%) were severe. Intravenous fluid, ondansetron, and corticosteroids were administered in 83.3, 72.7, and 66.7% of the patients, respectively; one patient required hospitalization. A reaction was most likely with fish (odds ratio [OR] 2.878 [95% confidence interval {CI}, 1.279-6.473]; p = 0.011), and least likely with cow's milk (OR 0.268 [95% CI, 0.082-0.872]; p = 0.029). Of the 36 OFCs with egg yolk, 23 patients had a failed OFC, and of the 17 OFCs with egg white (all tolerant to egg yolk), only 2 patients had a failed result. Interestingly, two patients tolerated baked whole egg but not egg yolk. In cow's milk FPIES, two patients could consume fermented milk but not fresh milk. Of the 11 patients with anchovy-triggered FPIES, 6 tolerated sea bass, and 5 tolerated trout, whereas 4 patients with sea bass FPIES tolerated trout. Conclusion: The search for alternative food species, processing, or subdivision of a trigger food is common practice in FPIES, which reflects the expectations of children and their families. The experience gained can be put into practice and will contribute to the understanding of the disease mechanism.
Collapse
|
43
|
Ullberg J, Fech‐Bormann M, Fagerberg UL. Clinical presentation and management of food protein-induced enterocolitis syndrome in 113 Swedish children. Allergy 2021; 76:2115-2122. [PMID: 33605459 DOI: 10.1111/all.14784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy causing severe acute gastrointestinal symptoms and lethargy, mainly affecting infants and young children. There are geographic variations in its clinical features. This study aimed to describe the clinical characteristics and management of FPIES in Swedish children. METHODS The study included children who presented with acute FPIES during 2008-2017. All Swedish pediatric departments (n = 32) were invited to report their known patients. Data were collected through chart reviews and interviews with parents. RESULTS Eighteen pediatric departments contributed, and 113 patients were included. Most had a family history of atopy (74%), and 51% had an atopic disease. Common trigger foods were cow's milk (26%), fish (25%), oat (22%), and rice (8%). Most patients (85%) reacted to a single food. The median age at first reaction was 3.9 months for cow's milk and 6.0 months for other foods (p < 0.001, range 1.0 month to 9 years). Repetitive vomiting (100%), lethargy (86%), and pallor (61%) were common symptoms; 40% had diarrhea. Sixty percent visited the emergency department, and 27% of all patients were hospitalized. Most patients were diagnosed clinically (81%). Specific IgE for the trigger food was positive in 4/89 tested patients (4%), and skin prick test for the trigger food was positive in 1/53 tested patients (2%). CONCLUSIONS In our Swedish study of 113 children, cow's milk, fish, and oat were the commonest trigger foods. Most patients reacted to a single food, and IgE sensitization was rare.
Collapse
Affiliation(s)
- Josefin Ullberg
- Department of Pediatrics Västmanland Hospital Västerås Sweden
| | | | - Ulrika L. Fagerberg
- Department of Pediatrics Västmanland Hospital Västerås Sweden
- Center for Clinical Research Region Västmanland/Uppsala University, Västmanland hospital Västerås Sweden
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
| |
Collapse
|
44
|
Di Chio T, Sokollik C, Peroni DG, Hart L, Simonetti G, Righini-Grunder F, Borrelli O. Nutritional Aspects of Pediatric Gastrointestinal Diseases. Nutrients 2021; 13:nu13062109. [PMID: 34205445 PMCID: PMC8235230 DOI: 10.3390/nu13062109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively “harmless” nature. Apart from a diet’s therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical “side effects”, however, it should be emphasized that any dietary modification might have negative consequences on children’s growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.
Collapse
Affiliation(s)
- Teresa Di Chio
- Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland;
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Christiane Sokollik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Diego G. Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy;
| | - Lara Hart
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Giacomo Simonetti
- Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland;
- Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Franziska Righini-Grunder
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street, London WC1N 3JH, UK
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| |
Collapse
|
45
|
Food protein-induced enterocolitis syndrome: epidemiology and comorbidities. Curr Opin Allergy Clin Immunol 2021; 20:168-174. [PMID: 31977448 DOI: 10.1097/aci.0000000000000615] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW First described in the mid 20th century, it was just in the last decade that diagnostic and treatment guidelines for food protein-induced enterocolitis syndrome (FPIES) were established. Awareness of the diagnosis is improving, and epidemiologic data are emerging. RECENT FINDINGS Recent studies suggest that FPIES may affect as many as 0.5% of children worldwide. FPIES in adults is usually triggered by seafood and may be more common than previously thought. Many patients with FPIES have other allergic disorders. SUMMARY With refined diagnostic criteria and improved awareness, FPIES is now diagnosed with increasing frequency, and epidemiologic data are emerging. FPIES appears to be increasing in prevalence, and the frequent association with other allergic disorders suggests a shared predisposition or immune mechanism that remains to be elucidated.
Collapse
|
46
|
Abreu-Ramírez MG, García-Gutiérrez I, Seoane-Reula ME, Infante S. Food protein-induced enterocolitis syndrome in monochorial monoamniotic twins. Ann Allergy Asthma Immunol 2021; 127:274-275. [PMID: 34004278 DOI: 10.1016/j.anai.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - María Elena Seoane-Reula
- Section of Paediatric Immunology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Sonsoles Infante
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.
| |
Collapse
|
47
|
Nowak-Wegrzyn A, Berin MC, Mehr S. Food Protein-Induced Enterocolitis Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:24-35. [PMID: 31950904 DOI: 10.1016/j.jaip.2019.08.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 01/01/2023]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that manifests with projectile, repetitive emesis that can be followed by diarrhea and may be accompanied by lethargy, hypotonia, hypothermia, hypotension, and metabolic derangements. FPIES usually starts in infancy although onset at older ages is being increasingly recognized. FPIES is not rare, with the cumulative incidence of FPIES in infants estimated to be 0.015% to 0.7%, whereas the population prevalence in the US infants was 0.51%. FPIES diagnosis is challenging and might be missed because of later (1-4 hours) onset of symptoms after food ingestion, lack of typical allergic skin and respiratory symptoms, and food triggers that are perceived to be hypoallergenic. Diagnosis is based on the recognition of symptoms because there are no biomarkers of FPIES. The pathophysiology remains obscure although activation of the innate immune compartment has been detected. Management relies of avoidance of food triggers, treatment of accidental exposures, and periodic re-evaluations with supervised oral food challenges to monitor for resolution. There are no strategies to accelerate development of tolerance in FPIES. Here we review the most important current concepts in epidemiology, pathophysiology, diagnosis, and management of FPIES.
Collapse
Affiliation(s)
- Anna Nowak-Wegrzyn
- Department of Pediatrics, New York University Langone Health, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
| | - M Cecilia Berin
- Precision Immunology Institute, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sam Mehr
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
48
|
Argiz L, Infante S, Machinena A, Bracamonte T, Echeverria L, Prieto A, Garriga T, Vila L, Gonzalez-Delgado P, Garcia-Magan C, Garcia E, Carballeira I, Vazquez-Cortes S, Mori F, Barni S, Arasi S, Pascal M, Boyle RJ, Vazquez-Ortiz M. Children with acute food protein-induced enterocolitis syndrome from Spain and Italy usually tolerate all other food groups. Clin Exp Allergy 2021; 51:1238-1241. [PMID: 33960041 DOI: 10.1111/cea.13894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Laura Argiz
- Allergy Section, Clinica Universidad de Navarra, Madrid, Spain
| | - Sonsoles Infante
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute (IiSGM, Madrid, Spain
| | - Adrianna Machinena
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Teresa Bracamonte
- Paediatric Allergy Section, Severo Ochoa University Hospital, Madrid, Spain
| | - Luis Echeverria
- Paediatric Allergy Section, Severo Ochoa University Hospital, Madrid, Spain
| | - Ana Prieto
- Paediatric Allergy Section, General University Hospital, Malaga, Spain
| | - Teresa Garriga
- Paediatric Allergy Section, Vall D'Hebron University Hospital, "Growth and Development" Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Leticia Vila
- Paediatric Allergy Section, Teresa Herrera Hospital, Coruna, Spain
| | | | - Carlos Garcia-Magan
- Paediatrics Department. Hospital, Clinico Universitario de Santiago de Compostela, Coruna, Spain
| | - Emilio Garcia
- Paediatric Allergy Section, Arquitecto Marcide Hospital, Coruna, Spain
| | - Iria Carballeira
- Paediatric Allergy Section, Arquitecto Marcide Hospital, Coruna, Spain
| | | | - Francesca Mori
- Paediatric Allergy Department, Anna Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Paediatric Allergy Department, Anna Meyer Children's Hospital, Florence, Italy
| | - Stefania Arasi
- Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital (IRCCS, Rome, Italy
| | - Mariona Pascal
- Immunology Department, CDB, Hospital Clínic de Barcelona, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Robert J Boyle
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
| | | |
Collapse
|
49
|
Peanut-induced food protein-induced enterocolitis syndrome (FPIES) in infants with early peanut introduction. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:2117-2119. [PMID: 33346152 DOI: 10.1016/j.jaip.2020.12.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023]
|
50
|
Lee E, Barnes EH, Mehr S, Campbell DE. An exploration of factors associated with food protein-induced enterocolitis syndrome: Birth, infant feeding and food triggers. Pediatr Allergy Immunol 2021; 32:742-749. [PMID: 33411386 DOI: 10.1111/pai.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/30/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergic disorder with a well-characterized phenotype, but limited understanding of factors associated with food cross-reactivity, severity and tolerance. METHODS A retrospective cohort study spanning 20 years on children with acute FPIES from a single paediatric tertiary centre in New South Wales, Australia, focusing on identifying food trigger co-associations and factors associated with reaction severity, multiple trigger FPIES and/or tolerance was performed. RESULTS A total of 168 individuals with 329 recorded FPIES episodes between 1997 and 2017 were included. 49% were male. The median age at first reaction was 5 months, and median age at diagnosis was 9 months. 73% experienced at least one severe FPIES reaction. Rice (45%), cow's milk (30%) and soya (13%) were the most common triggers. Rice or cow's milk FPIES was strongly associated with increased odds of having multiple trigger FPIES. The odds of having multiple food FPIES and severe reactions were slightly decreased with vaginal delivery. No factors were associated with increased risk of severe reactions. Infants with rice and grains FPIES outgrew their reactions at an earlier age, compared to those with fish FPIES. CONCLUSIONS Rice remains the most common trigger in Australia with co-associations between rice/oats and cow's milk/soya observed. This suggests that taxonomically related foods may share similar protein structure and trigger similar mechanisms of antigen recognition. Vaginal delivery may have a mild protective effect on the development of multiple FPIES and severe reactions. No other features from birth or infant-feeding history influenced outcomes in FPIES.
Collapse
Affiliation(s)
- Eric Lee
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sam Mehr
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Dianne E Campbell
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| |
Collapse
|