1
|
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
|
2
|
Nucci AM, Samela K, Bobo E, Wessel J. Complementary food introduction practices in infants with intestinal failure. Nutr Clin Pract 2023; 38:177-186. [PMID: 35762260 DOI: 10.1002/ncp.10883] [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: 02/17/2022] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Oral intake in infants with intestinal failure (IF) may be limited due to intolerance or feeding difficulties. Guidelines for the introduction of semisolid or solid complementary foods (CFs) to infants with IF do not exist. CF intake and caloric contribution from CF is difficult to assess due to malabsorption and incomplete recording. The aim of this study was to identify institutional approaches to introducing CF to infants with IF. METHODS The American Society for Parenteral and Enteral Nutriton (ASPEN) Pediatric Intestinal Failure Section Registered Dietitian/Nutritionist (RDN) working group designed a 10-question online cloud-based survey to assess group member practice related to the introduction of CF to infants with IF. RESULTS Twenty-six surveys were completed. Thirteen (50%) RDNs recommend introduction of CF between 4 and 6 months of age. Nineteen (76%) recommend adding pureed foods to gastrostomy tube feedings. Seventeen (65%) follow standard infant feeding practice guidelines with half citing the American Academy of Pediatrics. Approximately half (44%) recommend introducing vegetables first and the majority (80%) recommend delaying the introduction of fruits. The vast majority (92%) recommend specific foods to minimize stool output including green beans, bananas, infant cereals, and meats/protein. CONCLUSION Institutional practices related to the introduction of CF to infants with IF vary. Similarities with first food choice and foods to avoid were observed. Evidenced-based practice guidelines for the introduction of CF to infants with IF need to be established to determine best practices for reducing stool output, encouraging weaning from parenteral nutrition, and achieving enteral autonomy.
Collapse
Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | - Kate Samela
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Connecticut Children's, Hartford, Connecticut, USA
| | - Elizabeth Bobo
- Department of Gastroenterology and Nutrition, Nemours Children's Health, Jacksonville, Florida, USA
| | - Jacqueline Wessel
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | |
Collapse
|
3
|
Maggi E, Parronchi P, Azzarone BG, Moretta L. A pathogenic integrated view explaining the different endotypes of asthma and allergic disorders. Allergy 2022; 77:3267-3292. [PMID: 35842745 DOI: 10.1111/all.15445] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/28/2023]
Abstract
The inflammation of allergic diseases is characterized by a complex interaction between type 2 and type 3 immune responses, explaining clinical symptoms and histopathological patterns. Airborne stimuli activate the mucosal epithelium to release a number of molecules impacting the activity of resident immune and environmental cells. Signals from the mucosal barrier, regulatory cells, and the inflamed tissue are crucial conditions able to modify innate and adaptive effector cells providing the selective homing of eosinophils or neutrophils. The high plasticity of resident T- and innate lymphoid cells responding to external signals is the prerequisite to explain the multiplicity of endotypes of allergic diseases. This notion paved the way for the huge use of specific biologic drugs interfering with pathogenic mechanisms of inflammation. Based on the response of the epithelial barrier, the activity of resident regulatory cells, and functions of structural non-lymphoid environmental cells, this review proposes some immunopathogenic scenarios characterizing the principal endotypes which can be associated with a precise phenotype of asthma. Recent literature indicates that similar concepts can also be applied to the inflammation of other non-respiratory allergic disorders. The next challenges will consist in defining specific biomarker(s) of each endotype allowing for a quick diagnosis and the most effective personalized therapy.
Collapse
Affiliation(s)
- Enrico Maggi
- Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Parronchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Lorenzo Moretta
- Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
4
|
Khalesi N, Mazloomi Nobandegani N, Khosravi N, Saboute M, Farahi SF, Shakeri Z, Allahqoli L, Alkatout I. Effect of Maternal Diet on Any Necrotizing Enterocolitis in Neonates: A Randomized Double-Blind Study. Breastfeed Med 2022; 17:647-652. [PMID: 35613385 PMCID: PMC9419928 DOI: 10.1089/bfm.2021.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The etiology of necrotizing enterocolitis (NEC) is controversially discussed. One of the most recently proposed causes of NEC is an allergy to cow's milk protein. This study was designed to evaluate the effect of a maternal diet without bovine protein on the incidence of any NEC in very low birth weight (VLBW) infants. Materials and Methods: A pilot randomized controlled clinical trial was performed at Akbarabadi Hospital, Tehran, Iran, from December 2019 to July 2020, in women with VLBW infants. One hundred twenty mothers with VLBW neonates were randomly assigned to the intervention or the control group (60 in each). In the intervention group, mothers were given a dairy-free diet during the first 14 days after the newborn's onset of feeding. No special diet was given to the control group. The primary outcome of the study was the rate of any NEC in neonates, which was compared between groups. Any NEC was defined as Bell stage I or greater. Results: The minimum and maximum gestational ages were 26 and 33 weeks, respectively. The minimum birth weight of neonates was 700 g. The two groups did not differ significantly in terms of demographic and preinterventional clinical characteristics. Any NEC was reported in 0% and 10% (5/52) of neonates in the intervention and control groups, respectively; the difference was statistically significant (p = 0.028). The NEC symptoms began ∼34 days after birth. Four cases of NEC were classified as Bell stage I, and one was classified as Bell stage II. No statistical association was registered between sex, gestational age, birth weight, and the onset of feeding with the incidence of any NEC. Conclusion: The use of a cow's milk protein-free diet in mothers and exclusive breastfeeding in preterm VLBW infants may reduce the incidence of NEC. We recommend further studies with larger sample sizes in a multicenter setting. The study was registered at the Iranian Registry of Clinical Trials (IRCT20200415047086N1).
Collapse
Affiliation(s)
- Nasrin Khalesi
- Department of Neonatology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Narges Mazloomi Nobandegani
- Department of Neonatology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nastaran Khosravi
- Department of Neonatology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Saboute
- Department of Neonatology, Akbar Abadi Hospital, Iran University of Medical Sciences, (IUMS), Tehran, Iran
| | - Seyyede Faride Farahi
- Department of Neonatology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zinat Shakeri
- Department of Neonatology, Aliasghar Children's Hospital, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Leila Allahqoli
- Midwifery Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|
5
|
Bird JA, Leonard S, Groetch M, Assa'ad A, Cianferoni A, Clark A, Crain M, Fausnight T, Fleischer D, Green T, Greenhawt M, Herbert L, Lanser BJ, Mikhail I, Mustafa S, Noone S, Parrish C, Varshney P, Vlieg-Boerstra B, Young MC, Sicherer S, Nowak-Wegrzyn A. Conducting an Oral Food Challenge: An Update to the 2009 Adverse Reactions to Foods Committee Work Group Report. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:75-90.e17. [PMID: 31950914 DOI: 10.1016/j.jaip.2019.09.029] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
Abstract
Oral food challenges are an integral part of an allergist's practice and are used to evaluate the presence or absence of allergic reactivity to foods. A work group within the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology was formed to update a previously published oral food challenge report. The intention of this document was to supplement the previous publication with additional focus on safety, treatment of IgE-mediated allergic reactions, guidance for challenges in infants and adults, psychosocial considerations for children and families participating in an oral food challenge, specific guidance for baked milk or baked egg challenges, masking agents and validated blinding recipes for common food allergens, and recommendations for conducting and interpreting challenges in patients with suspected food protein-induced enterocolitis syndrome. Tables and figures within the report and an extensive online appendix detail age-specific portion sizes, appropriate timing for antihistamine discontinuation, serum and skin test result interpretation, written consents, and instructional handouts that may be used in clinical practice.
Collapse
Affiliation(s)
- J Andrew Bird
- University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Stephanie Leonard
- University of California, San Diego, Calif; Rady Children's Hospital, San Diego, Calif
| | - Marion Groetch
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amal Assa'ad
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - David Fleischer
- Children's Hospital Colorado, Denver, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Todd Green
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Matthew Greenhawt
- Children's Hospital Colorado, Denver, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Linda Herbert
- Children's National Hospital, Washington, DC; GW School of Medicine and Health Sciences, George Washington University, Washington, DC
| | | | - Irene Mikhail
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shahzad Mustafa
- Rochester Regional Health, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sally Noone
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Pooja Varshney
- Dell Children's Medical Center, Austin, Texas; Dell Medical School at University of Texas Austin, Austin, Texas
| | - Berber Vlieg-Boerstra
- OLVG, Department of Pediatrics, Amsterdam, The Netherlands; Department of Nutrition & Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | - Scott Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | |
Collapse
|
6
|
Su KW, Shreffler WG, Yuan Q. Gastrointestinal immunopathology of food protein-induced enterocolitis syndrome and other non-immunoglobulin E-mediated food allergic diseases. Ann Allergy Asthma Immunol 2021; 126:516-523. [PMID: 33667639 DOI: 10.1016/j.anai.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide a concise summary of the current literature regarding gastrointestinal immunopathology of food protein-induced enterocolitis syndrome (FPIES) and other non-immunoglobulin E (IgE)-mediated food allergic diseases. DATA SOURCES Data were extracted from PubMed, MEDLINE, and ScienceDirect databases. STUDY SELECTIONS Original articles, review articles, and guidelines published in the past 5 years in peer-reviewed journals were first summarized. The original articles cited were then reviewed and relevant results were extracted. RESULTS Patients with FPIES and non-IgE-mediated food allergic diseases developed vomiting, diarrhea, and food aversion expelled food allergen from their bodies. Aside from T helper type 2 (TH2) immunity, TH1, TH17, innate immunity, and epithelial mucosal barrier defect were also found to be important in the pathogenesis. Eosinophils, widely identified in the biopsy samples, were key players or were late-recruited cells for tissue repairs in those diseases. Intestinal dysbiosis and their metabolites stimulated enterochromaffin cells or enteroendocrine cells to produce serotonin, interfering with intestinal motility and subsequently affecting brain function. FPIES and non-IgE-mediated food allergic diseases were likely part of the atopic march. Allergic inflammation in intestinal mucosa might result in subsequent inflammation in the airway mucosa, suggesting the theory of "one mucosa, one disease." CONCLUSION The immune responses of FPIES and non-IgE-mediated food allergic diseases were not limited to the gastrointestinal tract, but also trigger wider inflammatory responses beyond it. Further research will be required to determine the systemic effect and intestinal microbiome of those diseases.
Collapse
Affiliation(s)
- Kuan-Wen Su
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Wayne G Shreffler
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Qian Yuan
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
7
|
Management of acute food protein-induced enterocolitis syndrome emergencies at home and in a medical facility. Ann Allergy Asthma Immunol 2021; 126:482-488.e1. [PMID: 33493640 DOI: 10.1016/j.anai.2021.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/24/2020] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Acute food protein-induced enterocolitis syndrome (FPIES) is characterized by delayed repetitive vomiting after ingestion of a trigger food, and severe reactions may lead to dehydration, hypotension, and shock. We provide recommendations on management of FPIES emergencies in a medical facility and at home. DATA SOURCES This review summarizes the literature on clinical context, pathophysiology, presentation, and treatment of FPIES emergencies. STUDY SELECTIONS We referred to the 2017 International Consensus Guidelines for the Diagnosis and Management of FPIES and performed a literature search identifying relevant recent primary articles and review articles on clinical management. RESULTS Management of FPIES emergencies in a medical facility is based on severity of symptoms and involves rehydration, ondansetron, and corticosteroids. A proactive approach for reactions occurring at home involves prescribing oral ondansetron and providing an individualized treatment plan based on the evolution of symptoms and severity of past reactions. A better understanding of the pathophysiology of FPIES and randomized trials on ondansedron and cocorticosteroid use could lead to more targeted treatments. CONCLUSION Children with FPIES are at risk for severe symptoms constituting a medical emergency. Management of FPIES emergencies is largely supportive, with treatment tailored to the symptoms, severity of the patient's condition, location of reaction, and reaction history.
Collapse
|
8
|
Li DH, Wong-Pack A, Macikunas AL, Kim H. Adults with possible food protein-induced enterocolitis syndrome with crustacean ingestion. Allergy Asthma Clin Immunol 2020; 16:99. [PMID: 33292583 PMCID: PMC7659059 DOI: 10.1186/s13223-020-00497-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background Food protein-induced enterocolitis (FPIES), an entity previously thought to only affect children, has been increasingly described in adults. In this study, we report a Canadian cohort of 19 adolescents and adults with recurrent non-immunoglobulin E (IgE)-mediated gastrointestinal symptoms after crustacean ingestion, consistent with FPIES. Methods We conducted a retrospective chart review of patients in an outpatient allergy clinic from January 2005 to May 2020. Electronic records were searched using keywords for crustaceans and for symptoms consistent with FPIES. We included patients with gastrointestinal symptoms specifically to crustaceans on more than one occasion, who were 14 years or older at the time of index reaction. Exclusion criteria included symptoms suggestive of an IgE-mediated anaphylactic reaction or a likely alternative diagnosis. We identified 19 patients for our cohort who met the criteria. Results Our cohort was 68.4% female (13) and 32.6% (6) male. The average age at first reaction to crustaceans was 34 years old with a range of 14–68 years (median = 28 years; IQR = 32 years). Time from ingestion to beginning of symptoms ranged from 3 min to 6.5 h, with an average of 2.8 h (median = 2 h; IQR = 3.25 h). Duration of reaction ranged from less than a minute to over 48 h, with a mean of 9.4 h (median = 4 h; IQR = 7.75 h). Patients had 4.8 reactions on average; however, number of reactions ranged from 2 to 12.5 (median = 3, IQR = 3). All patients identified a “trigger” food in the crustacean group, and 12 subjects identified additional reactions to other seafood. Conclusions This case series will better characterize and advance our understanding of this disease entity in adults. There are key differences in the presentation of FPIES in adults compared to children, namely female predominance, difference in solid food trigger, and unpredictable time course. Future studies are needed to examine the pathophysiology and natural history of adult FPIES. Specific guidelines should be developed for the diagnosis and management in adults. Trial registration: retrospectively registered.
Collapse
Affiliation(s)
- Daniel H Li
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Wong-Pack
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea Leilani Macikunas
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
9
|
Cafone J, Greenhawt M, Ram G. Delayed Food Reaction Unresponsive to Epinephrine: A Difficult Case of FPIES. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:815-817. [PMID: 32037115 DOI: 10.1016/j.jaip.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Joseph Cafone
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Gita Ram
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.
| |
Collapse
|
10
|
Maciag MC, Bartnikas LM, Sicherer SH, Herbert LJ, Young MC, Matney F, Westcott-Chavez AA, Petty CR, Phipatanakul W, Bingemann TA. A Slice of Food Protein-Induced Enterocolitis Syndrome (FPIES): Insights from 441 Children with FPIES as Provided by Caregivers in the International FPIES Association. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1702-1709. [PMID: 32004746 DOI: 10.1016/j.jaip.2020.01.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy. There is little known about the demographic characteristics, food triggers, and risk factors for FPIES. OBJECTIVE To characterize the demographic characteristics, food triggers, risk factors, and management in children with FPIES. METHODS We retrospectively analyzed surveys completed by 410 caregiver-members of the International FPIES Association, both at a conference for families affected by FPIES and online. RESULTS Most of the children were female (50.7%), white (86.2%), and atopic (54.8%), with a median age of 2 years (ranging from 2 months to 19 years). The most common food groups avoided were grains (60.0%), cow's milk (52.4%), vegetables (42.7%), and fruits (38.0%). Avocado was the most commonly avoided fruit. Avoiding avocado was associated with increased likelihood of avoiding banana (P < .001). Of these children, 69.4% avoided at least 2 food groups because of FPIES, and 20.3% had a first-degree relative with FPIES. Having a first-degree relative with FPIES was associated with increased likelihood of avoiding multiple food groups (P = .035). CONCLUSIONS The most common food group avoided was grains, consistent with recent literature. Avocado avoidance was higher than previously reported, and this is the first report of an association between avocado and banana avoidance in FPIES. Avoiding multiple food groups because of FPIES was more common than previously reported. A large proportion of children in our cohort had first-degree relatives with FPIES, and, furthermore, having a first-degree relative with FPIES was significantly associated with the affected child avoiding multiple food groups.
Collapse
Affiliation(s)
- Michelle C Maciag
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Lisa M Bartnikas
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Scott H Sicherer
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Linda J Herbert
- Division of Allergy and Immunology, Children's National Medical Center, Washington, DC
| | - Michael C Young
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Fallon Matney
- International FPIES Association (I-FPIES), Point Pleasant Beach, NJ
| | | | - Carter R Petty
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Theresa A Bingemann
- Allergy and Clinical Immunology, Rochester Regional Health and the University of Rochester School of Medicine and Dentistry, Rochester, NY
| |
Collapse
|
11
|
Abstract
The epidemiology of inflammatory bowel disease has changed over the past 4 decades. The incidence is rising dramatically and the age of onset has become younger. This changing landscape of inflammatory bowel disease reflects the new recognition that the youngest children with inflammatory bowel disease are enriched in cases with underlying primary immunodeficiency and monogenic causes. The management of these cases can be quite different, with specific genetic etiologies supporting unique interventions and some requiring hematopoietic cell transplantation for effective treatment.
Collapse
Affiliation(s)
- Judith R Kelsen
- Division of Gastroenterology, Hepatology and Nutrition, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Pierre Russo
- Department of Pathology, Division of Allergy Immunology, The Children's Hospital of Philadelphia, ARC 1216-I, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Kathleen E Sullivan
- Division of Allergy Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| |
Collapse
|
12
|
Infante S, Marco-Martín G, Zubeldia JM, Fuentes-Aparicio V, Alvarez-Perea A, Cabrera-Freitag P, Morales-Cabeza C, Zapatero L. Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement? Int Arch Allergy Immunol 2019; 179:215-220. [PMID: 30982049 DOI: 10.1159/000497486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Among the solid foods, rice is one of the most causative foods worldwide, but it varies depending on the geographic area. In the Mediterranean countries, fish is one of the most important triggers of FPIES. There is not a specific biological marker for the disease that allows us to confirm the diagnosis or to predict when tolerance to the offending food has been achieved, so all patients with a FPIES diagnosis undergo an oral food challenge (OFC) at least once. The OFC is a risky procedure and many patients develop severe symptoms. OBJECTIVE We sought to evaluate the safety of a new OFC protocol in children with fish-FPIES. METHODS A retrospective study was performed over a 22-year period (1996-2018). We compared two methodologies used in the OFC: Method 1 that consisted in giving several doses during the same day versus Method 2 that consisted in giving a unique dose per day on 2 or three non-consecutive days. RESULTS A total of 75 positive OFC with fish done in 40 children were included. Forty-three (57.3%) OFC were performed following Method 1 and 32 (42.7%) with Method 2.The severity of the symptoms of the OFC done with Method 1 was mostly moderate (41.9%) followed by severe (39.5%) and mild (18.6%). The adverse reactions with Method 2 were mostly mild (68.8%) and only 18.8 and 12.5% presented moderate or severe symptoms, respectively. CONCLUSIONS OFC performed in children with fish-FPIES are risky and many patients develop moderate or severe symptoms after this procedure. We propose a new protocol that has demonstrated to improve safety.
Collapse
Affiliation(s)
- Sonsoles Infante
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain, .,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain,
| | - Guadalupe Marco-Martín
- Allergy Unit, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - José Manuel Zubeldia
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain.,Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain
| | - Victoria Fuentes-Aparicio
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Alberto Alvarez-Perea
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Paula Cabrera-Freitag
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Cristina Morales-Cabeza
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Lydia Zapatero
- Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| |
Collapse
|
13
|
Necrotizing enterocolitis comes in different forms: Historical perspectives and defining the disease. Semin Fetal Neonatal Med 2018; 23:370-373. [PMID: 30100524 DOI: 10.1016/j.siny.2018.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The specific cause of what is commonly referred to as necrotizing enterocolitis (NEC) disease has been elusive largely because it is becoming clear that this entity represents more than one disease with multifactorial pathogenic mechanisms. Furthermore, finding clear and consistent diagnostic biomarkers will be difficult until the different subsets of what we are calling this disease are better delineated. In this introductory chapter, we discuss different disease entities that are frequently termed "NEC" in the newborn infant. We hope this will set the stage for more focused research and development of preventative measures for at least the most common forms of this disease.
Collapse
|
14
|
Lenfestey MW, de la Cruz D, Neu J. Food Protein-Induced Enterocolitis Instead of Necrotizing Enterocolitis? A Neonatal Intensive Care Unit Case Series. J Pediatr 2018; 200:270-273. [PMID: 29803301 DOI: 10.1016/j.jpeds.2018.04.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 12/19/2022]
Abstract
Necrotizing enterocolitis is an important disease in infants born premature. However, other disease entities present with similar signs and symptoms. This series reviews 5 atypical cases initially diagnosed as necrotizing enterocolitis that may be more consistent with food protein-induced enterocolitis. Food protein-induced enterocolitis may be underdiagnosed in this population.
Collapse
Affiliation(s)
- Mary W Lenfestey
- Division of Pediatric Gastroenterology, University of Florida, Gainesville, FL
| | - Diomel de la Cruz
- Department of Pediatrics, Neonatology, University of Florida, Gainesville, FL
| | - Josef Neu
- Department of Pediatrics, Neonatology, University of Florida, Gainesville, FL.
| |
Collapse
|
15
|
Infante S, Marco-Martín G, Sánchez-Domínguez M, Rodríguez-Fernández A, Fuentes-Aparicio V, Alvarez-Perea A, Cabrera-Freitag P, Morales-Cabeza C, Zubeldia JM, Zapatero L. Food protein-induced enterocolitis syndrome by fish: Not necessarily a restricted diet. Allergy 2018; 73:728-732. [PMID: 29052246 DOI: 10.1111/all.13336] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple-food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow-up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets.
Collapse
Affiliation(s)
- S. Infante
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - G. Marco-Martín
- Allergy Department; Hospital Clínico San Carlos; Madrid Spain
| | - M. Sánchez-Domínguez
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - A. Rodríguez-Fernández
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - V. Fuentes-Aparicio
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - A. Alvarez-Perea
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - P. Cabrera-Freitag
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - C. Morales-Cabeza
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| | - J. M. Zubeldia
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
- Biomedical Research Network on Rare Diseases (CIBERER)-U761; Madrid Spain
| | - L. Zapatero
- Paediatric Allergy Unit; Hospital Infantil Universitario Gregorio Marañón; Madrid Spain
- Gregorio Marañón Health Research Institute (IiSGM); Madrid Spain
| |
Collapse
|
16
|
Meyer R, Groetch M, Venter C. When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:383-399. [DOI: 10.1016/j.jaip.2017.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/04/2017] [Accepted: 09/16/2017] [Indexed: 12/18/2022]
|
17
|
Ribeiro A, Moreira D, Costa C, Pinto Pais I. Food protein-induced enterocolitis syndrome: a challenging diagnosis. BMJ Case Rep 2018; 2018:bcr-2017-222822. [PMID: 29437805 DOI: 10.1136/bcr-2017-222822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity triggered by food proteins. It may present acutely, with repetitive vomiting, diarrhoea and lethargy leading to dehydration and eventually shock or insidiously with intermittent emesis, chronic diarrhoea or failure to thrive. We describe a paediatric male patient with recurrent sepsis-like episodes of fever, lethargy, ashen-grey skin colouration and vomiting followed by diarrhoea. These episodes were triggered by cow's milk formula and grains. Laboratory tests revealed leucocytosis, thrombocytosis, metabolic acidosis and elevated C reactive protein. After exclusion of other differential diagnoses, the diagnosis of FPIES was established on clinical improvement with withdrawal of the offending food and positive oral food challenge. FPIES diagnosis requires a high index of suspicion and is frequently delayed, which contributes to an increased morbidity. This is due to the wide spectrum of clinical presentations and due to the absence of specific diagnostic tests.
Collapse
Affiliation(s)
- Andreia Ribeiro
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Diana Moreira
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Costa
- Pediatric Gastroenterology, Centro Hospitalar Gaia Espinho, Vila Nova de Gaia, Portugal
| | | |
Collapse
|
18
|
Bingemann TA, Sood P, Järvinen KM. Food Protein-Induced Enterocolitis Syndrome. Immunol Allergy Clin North Am 2018; 38:141-152. [DOI: 10.1016/j.iac.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Weinberger T, Feuille E, Thompson C, Nowak-Węgrzyn A. Chronic food protein-induced enterocolitis syndrome: Characterization of clinical phenotype and literature review. Ann Allergy Asthma Immunol 2017; 117:227-33. [PMID: 27613454 DOI: 10.1016/j.anai.2016.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Tamar Weinberger
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth Feuille
- Jaffe Food Allergy Institute, Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cecilia Thompson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
20
|
Muraro A, Lemanske RF, Castells M, Torres MJ, Khan D, Simon HU, Bindslev-Jensen C, Burks W, Poulsen LK, Sampson HA, Worm M, Nadeau KC. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy 2017; 72:1006-1021. [PMID: 28122115 DOI: 10.1111/all.13132] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 12/30/2022]
Abstract
This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease.
Collapse
Affiliation(s)
- A. Muraro
- Food Allergy Referral Centre Veneto Region; Department of Women and Child Health; Padua General University Hospital; Padua Italy
| | - R. F. Lemanske
- Department of Pediatrics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - M. Castells
- Drug Hypersensitivity and Desensitization Center; Brigham & Women's Hospital; Harvard Medical School; Boston MA USA
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - D. Khan
- Division of Allergy & Immunology; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - W. Burks
- Department of Pediatrics; University of North Carolina; Chapel Hill NC USA
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte Hospital; Copenhagen Denmark
| | - H. A. Sampson
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Worm
- Klinik für Dermatologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. C. Nadeau
- Department of Medicine; Stanford University School of Medicine; Stanford CA USA
- Sean N. Parker Center for Allergy and Asthma Research; Stanford University School of Medicine; Stanford CA USA
| |
Collapse
|
21
|
International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2017; 139:1111-1126.e4. [PMID: 28167094 DOI: 10.1016/j.jaci.2016.12.966] [Citation(s) in RCA: 371] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/07/2016] [Accepted: 12/21/2016] [Indexed: 01/22/2023]
Abstract
Food protein-induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available.
Collapse
|
22
|
Allergic enteritis in children. GASTROENTEROLOGY REVIEW 2017; 12:1-5. [PMID: 28337229 PMCID: PMC5360665 DOI: 10.5114/pg.2017.65677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/21/2015] [Indexed: 01/27/2023]
Abstract
The gastrointestinal form of food allergy is very common in children. The most frequently observed types are allergic proctitis and proctocolitis. In most cases the symptoms subside within the first 2 months of life. The babies seem healthy, and the only abnormality is a small amount of blood in stool. Symptoms can also include small intestine inflammation and colitis. Patients may present with irritability, abdominal pain, flatulence, colic, postprandial vomiting, chronic diarrhoea, and hindered physical development. The diagnosis of allergic enteritis is based on the clinical examination and the results of additional tests including an endoscopy of the lower digestive tract with histopathological assessment. Cow’s milk proteins are the most common nutrition proteins responsible for the development of the symptoms of allergic enteritis. The most essential method of treating allergic enteritis is the elimination diet. The symptoms should subside within 1–2 weeks from the beginning of the diet.
Collapse
|
23
|
Kaplan JL, Rincon SP, Duhaime AC. Case 40-2016. A 14-Month-Old Girl with Recurrent Vomiting. N Engl J Med 2016; 375:2583-2593. [PMID: 28029921 DOI: 10.1056/nejmcpc1613468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jess L Kaplan
- From the Departments of Pediatrics (J.L.K.), Radiology (S.P.R.), and Neurosurgery (A.-C.D.), Massachusetts General Hospital, and the Departments of Pediatrics (J.L.K.), Radiology (S.P.R.), and Neurosurgery (A.-C.D.), Harvard Medical School - both in Boston
| | - Sandra P Rincon
- From the Departments of Pediatrics (J.L.K.), Radiology (S.P.R.), and Neurosurgery (A.-C.D.), Massachusetts General Hospital, and the Departments of Pediatrics (J.L.K.), Radiology (S.P.R.), and Neurosurgery (A.-C.D.), Harvard Medical School - both in Boston
| | - Ann-Christine Duhaime
- From the Departments of Pediatrics (J.L.K.), Radiology (S.P.R.), and Neurosurgery (A.-C.D.), Massachusetts General Hospital, and the Departments of Pediatrics (J.L.K.), Radiology (S.P.R.), and Neurosurgery (A.-C.D.), Harvard Medical School - both in Boston
| |
Collapse
|
24
|
Abstract
Cow's milk protein allergy (CMPA) is a common condition encountered in children with incidence estimated as 2% to 7.5% in the first year of life. Formula and breast-fed babies can present with symptoms of CMPA. It is important to accurately diagnose CMPA to avoid the consequences of either under- or overdiagnosis. CMPA is classically categorized into immunoglobulin E (IgE)- or non-IgE-mediated reaction that vary in clinical manifestations, diagnostic evaluation, and prognosis. The most commonly involved systems in patients with CMPA are gastrointestinal, skin, and respiratory. Evaluation of CMPA starts with good data gathering followed by testing if indicated. Treatment is simply by avoidance of cow's milk protein (CMP) in the child's or mother's diet, if exclusively breast-feeding. This article reviews the definition, epidemiology, risk factors, pathogenesis, clinical presentation, evaluation, management, and prognosis of CMPA and provides an overview of different options for formulas and their indication in the treatment of CMPA.
Collapse
Affiliation(s)
- Grace Mousan
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Deepak Kamat
- Children's Hospital of Michigan, Detroit, MI, USA
| |
Collapse
|
25
|
Kimura M, Ito Y, Tokunaga F, Meguro T, Shimomura M, Morishita H, Seto S. Increased C-reactive protein and fever in Japanese infants with food protein-induced enterocolitis syndrome. Pediatr Int 2016; 58:826-30. [PMID: 26824628 DOI: 10.1111/ped.12938] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 01/14/2016] [Accepted: 01/26/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Increased C-reactive protein (CRP) and fever are observed in some infants with food protein-induced enterocolitis syndrome (FPIES) in Japan, but the reproducibility of these findings has not yet been confirmed on oral food challenge (OFC). METHODS Fourteen infants with FPIES induced by cow's milk (CM) formula were enrolled. OFC using CM formula was performed on each infant once or repeatedly (total 18 tests), with a stepwise incremental protocol in an infection-controlled setting. CRP was measured 24 h after the last ingestion of the CM formula. RESULTS Increased CRP was observed in 11 of the 18 OFC conducted (median, 2.60 mg/dL; range, 0.22-4.84 mg/dL). Fever was induced in six occasions during OFC. Serum CRP in the patients with fever increased to median 3.76 mg/dL (range, <0.7-4.84 mg/dL), which was significantly higher than that of the patients without fever (median <0.1 mg/dL; range, <0.1-2.6 mg/dL; P < 0.001). CRP during OFC significantly correlated with that at disease onset (rs = 0.62, P < 0.02). Three of the four patients with fever at disease onset also had fever during OFC. CONCLUSIONS Increased CRP and fever are reproducible during OFC in some infants with FPIES, suggesting that these are not accidental phenomena, but instead are associated with FPIES itself in Japanese patients.
Collapse
Affiliation(s)
- Mitsuaki Kimura
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan.
| | - Yasunori Ito
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
| | - Fumika Tokunaga
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
| | - Takaaki Meguro
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
| | - Masaki Shimomura
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
| | - Hideaki Morishita
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
| | - Shiro Seto
- Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
| |
Collapse
|
26
|
Yokoyama S, Sekioka A, Utsunomiya H, Yokoyama K, Ikeda Y, Hara S, Yoshida A. Eosinophilic enteritis due to cow's milk allergy: Possible cause of anastomosis failure following repair of focal intestinal perforation. Pediatr Int 2016; 58:493-496. [PMID: 26841092 DOI: 10.1111/ped.12835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/10/2015] [Accepted: 09/15/2015] [Indexed: 11/27/2022]
Abstract
Reports of cow's milk allergy (CMA) after neonatal gastrointestinal surgery have recently increased. In recent years it has been suggested that the development of CMA after gastrointestinal surgery in newborn infants is due to an immune function. In addition, the development of CMA might be synergistically exacerbated by congenital abnormalities of the intestinal mucosa, general conditional changes and local damage to the intestine by invasive surgery, and poor pre- or post-surgical nutrition. CMA manifests as a variety of symptoms, such as mild vomiting and bloody stool, decreased activity, poor oral intake, and ileus. CMA may also rarely cause gastrointestinal perforation. Here, we report the case of a newborn infant who developed CMA following repair of focal small intestinal perforation, in which eosinophilic enteritis was suspected to be a possible cause of anastomosis leakage.
Collapse
Affiliation(s)
- Satoshi Yokoyama
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Akinori Sekioka
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Hirofumi Utsunomiya
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Koji Yokoyama
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Yuka Ikeda
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Shigeto Hara
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Akira Yoshida
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| |
Collapse
|
27
|
Simon D, Cianferoni A, Spergel JM, Aceves S, Holbreich M, Venter C, Rothenberg ME, Terreehorst I, Muraro A, Lucendo AJ, Schoepfer A, Straumann A, Simon HU. Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity. Allergy 2016; 71:611-20. [PMID: 26799684 DOI: 10.1111/all.12846] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 12/19/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.
Collapse
Affiliation(s)
- D. Simon
- Department of Dermatology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - A. Cianferoni
- Division of Allergy and Immunology; Children's Hospital Philadelphia; University of Pennsylvania; Philadelphia PA USA
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - J. M. Spergel
- Division of Allergy and Immunology; Children's Hospital Philadelphia; University of Pennsylvania; Philadelphia PA USA
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - S. Aceves
- Division of Allergy and Immunology; Department of Pediatrics and Medicine; Center for Infection, Inflammation, and Immunology; La Jolla CA USA
| | - M. Holbreich
- Allergy and Asthma Consultants; Indianapolis IN USA
| | - C. Venter
- Division of Allergy and Immunology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
| | - M. E. Rothenberg
- Division of Allergy and Immunology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam The Netherlands
| | - A. Muraro
- Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - A. J. Lucendo
- Department of Gastroenterology; Hospital General de Tomelloso; Tomelloso Spain
| | - A. Schoepfer
- Division of Gastroenterology and Hepatology; Centre Hospitalier Universitaire Vaudois/CHUV; Lausanne Switzerland
| | | | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| |
Collapse
|
28
|
FPIES: Reviewing the Management of Food Protein-Induced Enterocolitis Syndrome. Case Rep Pediatr 2016; 2016:1621827. [PMID: 27051548 PMCID: PMC4802010 DOI: 10.1155/2016/1621827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/28/2016] [Indexed: 12/22/2022] Open
Abstract
Purpose of Review. The aim of this review is to provide a case driven presentation of the presenting features and diagnostic criteria particularly focusing on the management of FPIES. It also summarises the natural history and resolution of cow's milk induced FPIES. Data Sources. OvidSP Database was used to search for literature using the keywords food protein-induced enterocolitis and FPIES. Recent Findings. The diagnosis of FPIES is often delayed following two or more presentations. Symptoms in the acute form include profuse vomiting usually 2–6 hours following ingestion of food. Vomiting may or may not be accompanied by diarrhoea. Management involves removing the causal food protein from diet. There is some concomitance in cow's milk and soya induced FPIES. Hence extensively hydrolysed formula is the milk of choice unless breast-feeding is carried out in which case that should be continued. Summary. FPIES is a complex form of non-IgE mediated food allergy. More awareness and knowledge of the condition are required to prevent misdiagnosis. Early diagnosis and removal of the culprit food protein improve the outcome. Good nutritional advice and clear management plans are important. More multicentre studies are required to reevaluate and produce consistent oral food challenge criteria and guidelines.
Collapse
|
29
|
Mattingly R, Mukkada V, Smith A, Pitts T. Optimizing an Aversion Feeding Therapy Protocol for a Child with Food Protein-Induced Enterocolitis Syndrome (FPIES). JOURNAL OF PULMONARY & RESPIRATORY MEDICINE 2016; 5. [PMID: 26779390 DOI: 10.4172/2161-105x.1000287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This case study examines the difficulties of treating food aversion in a 9-month old child with a diagnosis of Food Protein-Induced Enterocolitis Syndrome (FPIES). Given the need to first identify a set of "safe foods" with which to work, the twin goals of doing food challenges and minimizing aversion are initially not complimentary, and require an approach outside the standard of care. The chosen plan encouraged flexibility and a positive relationship with feeding-related items, while only introducing one food item at a time. Mom and child accomplished goals surrounding food play easily. She has successfully introduced a wide variety of new foods in small quantities and is currently working on reducing dependence on breast milk. Therapists must be prepared to modify currently accepted interventions to accommodate and support the required medical intervention.
Collapse
Affiliation(s)
- Rhonda Mattingly
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders School of Medicine, University of Louisville, USA
| | - Vincent Mukkada
- Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, USA
| | - Alan Smith
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders School of Medicine, University of Louisville, USA
| | - Teresa Pitts
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, School of Medicine, University of Louisville, USA
| |
Collapse
|
30
|
Abstract
Food allergies are increasing in prevalence. In order for pediatric clinicians to appropriately diagnose and manage food allergies, the characteristic signs and symptoms of these potentially severe reactions must be recognized. Unlike nonimmunologic adverse food reactions (such as lactose intolerance and food poisoning), food allergies by definition are immune-mediated responses that occur reproducibly on food ingestion. The varying clinical presentations of food allergy include IgE-mediated disorders, mixed IgE- and cell-mediated disorders, and cell-mediated food allergies. This review describes the clinical manifestations of each of these categories of food allergy, with special emphasis on recognition of food-induced anaphylaxis.
Collapse
Affiliation(s)
- Hemant P Sharma
- Division of Allergy and Immunology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Shweta Bansil
- Division of Allergy and Immunology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Burcin Uygungil
- Division of Allergy and Immunology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
31
|
Abstract
Eosinophilic gastrointestinal disease (EGID) can be classified as eosinophilic esophagitis (EoE) when the eosinophilia is limited to the esophagus or as eosinophilic gastritis (EG) if it is limited to the gastric tract, eosinophilic colitis (EC) if it is limited to the colon, and eosinophilic gastroenteritis (EGE) if the eosinophilia involves one or more parts of the gastrointestinal tract. EoE is by far the most common EGID. It is a well-defined chronic atopic disease due to a T helper type 2 (Th2) inflammation triggered often by food allergens. EoE diagnosis is done if an esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf). Globally accepted long-term therapies for EoE are the use of swallowed inhaled steroids or food antigen avoidance. The treatment of EoE is done not only to control symptoms but also to prevent complications such as esophageal stricture and food impaction. EGE cause non-specific gastrointestinal (GI) symptoms and are diagnosed if esophagogastroduodenoscopy (EGD)/colonoscopy show eosinophilia in one or more parts of the GI tract. They are rare diseases with an unclear pathogenesis, and they are poorly defined in terms of diagnostic criteria and treatment. Before initiating treatment of any EGE, it is imperative to conduct a differential diagnosis to exclude other causes of hypereosinophilia with GI localization. EGE are often poorly responsive to therapy and there is no commonly accepted long-term treatment. EG has many characteristics similar to EoE, including the fact that it is often due to a food allergen-driven Th2 inflammation; transcriptome analysis however shows that it is more a systemic disease and has a different gene signature than EoE. EC is a benign form of delayed food allergy in infant and is instead a difficult-to-treat severe inflammatory condition in older children and adults. EC in the latter groups can be a manifestation of drug allergy or autoimmune disease. Overall EGE, EC, and EG are rare and are a diagnosis of exclusion until more common causes of eosinophilia have been excluded.
Collapse
Affiliation(s)
- Antonella Cianferoni
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA,
| | | |
Collapse
|
32
|
Feuille E, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy. Curr Allergy Asthma Rep 2015; 15:50. [PMID: 26174434 DOI: 10.1007/s11882-015-0546-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Food protein-induced enterocolitis (FPIES), allergic proctocolitis (FPIAP), and enteropathy (FPE) are among a number of immune-mediated reactions to food that are thought to occur primarily via non-IgE-mediated pathways. All three are typically present in infancy and are triggered most commonly by cow's milk protein. The usual presenting features are vomiting with lethargy and dehydration in FPIES; bloody and mucous stools in FPIAP; and diarrhea with malabsorption and failure to thrive in FPE. Diagnosis is based on convincing history and resolution of symptoms with food avoidance; confirmatory diagnostic testing other than food challenge is lacking. The mainstay of management is avoidance of the suspected inciting food, with interval challenge to assess for resolution, which usually occurs in the first years of life. Studies published in the past few years clarify common presenting features, report additional culprit foods, address potential biomarkers, and suggest new management strategies.
Collapse
Affiliation(s)
- Elizabeth Feuille
- Jaffe Food Allergy Institute, Division of Pediatric Allergy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
33
|
High Prevalence of Neutrophil Cytoplasmic Autoantibodies in Infants with Food Protein-Induced Proctitis/Proctocolitis: Autoimmunity Involvement? J Immunol Res 2015; 2015:902863. [PMID: 26484355 PMCID: PMC4592904 DOI: 10.1155/2015/902863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Food protein-induced proctitis/proctocolitis (FPIP) is the most common noninfectious colitis in children in the first year of life. Along with the overall clinical symptoms, diarrhoea and rectal bleeding are the main manifestations of the disease. There is no routine noninvasive test that would be specific for this type of colitis. The aim of our study was to find a noninvasive laboratory test or tests that may be helpful in differential diagnosis of food protein-induced proctitis/proctocolitis. Methods. ANA, ANCA, ASCA, a-EMA, a-tTg, specific IgE, total IgE, IgG, IgA, IgM, and concentration of serum calprotectin were measured in a group of 25 patients with colitis and 18 children with other diagnoses. Results. Atypical-pANCA antibodies of IgG isotype were detected in the sera of 24 patients by the method of indirect immunofluorescence, and 5 patients showed also the positivity of IgA isotype. In control samples these autoantibodies were not detected. Other autoantibodies were not demonstrated in either patient or control group. Conclusions. Of the parameters tested in noninfectious colitis, atypical-pANCA on ethanol-fixed granulocytes appears to be a suitable serological marker of food protein-induced proctitis/proctocolitis and suggests a possible involvement of an autoimmune mechanisms in the pathogenesis of this disease.
Collapse
|
34
|
Urisu A, Ebisawa M, Ito K, Aihara Y, Ito S, Mayumi M, Kohno Y, Kondo N. Japanese Guideline for Food Allergy 2014. Allergol Int 2015; 63:399-419. [PMID: 25178179 DOI: 10.2332/allergolint.14-rai-0770] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Indexed: 01/08/2023] Open
Abstract
A food allergy is defined as "a phenomenon in which adverse reactions are caused through antigen-specific immunological mechanisms after exposure to given food." Various symptoms of food allergy occur in many organs. Food allergies are classified roughly into 4 clinical types: (1) neonatal and infantile gastrointestinal allergy, (2) infantile atopic dermatitis associated with food allergy, (3) immediate-type food allergy (urticaria, anaphylaxis, etc.), and (4) food dependent exercise-induced anaphylaxis and oral allergy syndrome (i.e., specific forms of immediate food allergy). The therapy for food allergies includes treatment of and prophylactic measures against hypersensitivity such as anaphylaxis. A fundamental prophylactic measure is the elimination diet. However, elimination diets should be used only if necessary because of the patient-related burden. For this purpose, it is very important that causative foods be accurately identified. There are a number of means available to identify causative foods, including the history taking, a skin prick test, detection of antigen-specific IgE antibodies in the blood, the basophil histamine release test, the elimination diet test, and the oral challenge test, etc. Of these, the oral challenge test is the most reliable. However, it should be conducted under the supervision of experienced physicians because it may cause adverse reactions, such as anaphylaxis.
Collapse
Affiliation(s)
- Atsuo Urisu
- Fujita Health University School of Medicine, Aichi, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Yukoh Aihara
- Aihara Allergy & Pediatric Clinic, Kanagawa, Japan
| | - Setsuko Ito
- Department of Food Science and Nutrition, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | | | | | - Naomi Kondo
- Heisei College of Health Science, Gifu, Japan
| |
Collapse
|
35
|
The controversial role of food allergy in infantile colic: evidence and clinical management. Nutrients 2015; 7:2015-25. [PMID: 25808260 PMCID: PMC4377897 DOI: 10.3390/nu7032015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/16/2015] [Accepted: 03/11/2015] [Indexed: 12/13/2022] Open
Abstract
Food allergies (FAs) are an increasing problem in Western countries, affecting up to 10% of young children. FAs are frequently associated with gastrointestinal manifestations. The role of FAs as a potential causative factor for infantile colic (IC) is still controversial. We report the most recent evidence on the pathogenesis, clinical and diagnostic aspects of FA-induced infantile colic (IC) and suggest a stepwise diagnostic approach. We selected articles on clinical and immunologic features, pathogenesis and management of FAs and IC from of 1981 to 2015. Original and review articles were identified through selective searches performed on PubMed, using the following terms: colic, infantile colic, food allergy and infantile colic, infantile colic treatment. The possible relationship between FAs and IC derives from the presence of dysmotility with visceral hypersensitivity and dysbiosis, demonstrated in both conditions, and the clinical response to dietary interventions. Unfortunately, the design of the studies, poor characterization of atopy and different dietary approaches limit the understanding of the importance of FAs in subjects with IC. The role of FAs in IC subjects without other symptoms of atopy remains controversial. However, where there is a suspicion of FAs, a short trial with an extensively hydrolyzed cow's proteins formula or, if breast fed, with maternal elimination diet may be considered a reasonable option.
Collapse
|
36
|
Anagnostou K, Meyer R, Fox A, Shah N. The rapidly changing world of food allergy in children. F1000PRIME REPORTS 2015; 7:35. [PMID: 25926986 PMCID: PMC4371379 DOI: 10.12703/p7-35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Food allergy is a common problem in childhood. The term is used to include both immunoglobulin E (IgE)-mediated and non-IgE-mediated food allergies, which have a significant effect on the quality of life of patients and their families. In this report, we aim to discuss recent advances in the diagnosis, management, and treatment modalities of food allergy in children.
Collapse
Affiliation(s)
- Katherine Anagnostou
- Department of Paediatric Allergy, Guy's and St Thomas' Hospitals NHS Foundation TrustWestminster Bridge Road, London, SE1 7EHUK
| | - Rosan Meyer
- Department of Paediatric Gastroenterology, Great Ormond Street Children's HospitalLondon, WC1N 3JHUK
| | - Adam Fox
- Department of Paediatric Allergy, Guy's and St Thomas' Hospitals NHS Foundation TrustWestminster Bridge Road, London, SE1 7EHUK
| | - Neil Shah
- Department of Paediatric Gastroenterology, Great Ormond Street Children's HospitalLondon, WC1N 3JHUK
- KULeuvenTargid - Herestraat 49, O&N1, Box 701 - 3000 LeuvenBelgium
| |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW To raise awareness among healthcare providers about the clinical and laboratory findings in acute and chronic food protein-induced enterocolitis syndrome (FPIES). RECENT FINDINGS FPIES can be caused by trivial exposure or rare foods. SUMMARY FPIES is a non-IgE-mediated reaction that usually presents with acute severe repetitive vomiting and diarrhea associated with lethargy, pallor, dehydration, and even hypovolemic shock. Manifestations resolve usually within 24-48 h of elimination of the causative food. In chronic cases, symptoms may include persistent diarrhea, poor weight gain, failure to thrive, and improvement may take several days after the food elimination. In the acute cases, laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking about 6 h postingestion. Depending on the severity, metabolic acidosis and methemoglobinemia may occur. In chronic cases, anemia, hypoalbuminemia and eosinophilia may be seen. Radiologic evaluation or other procedures, such as endoscopy and gastric juice analysis may show nonspecific abnormal findings. The diagnosis is based on clinical manifestations. Further studies looking at the phenotypes of FPIES are needed to identify clinical subtypes, and to understand the predisposing factors for developing FPIES compared with immediate-type, IgE-mediated gastroenteropathies.
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Food protein-induced enterocolitis syndrome (FPIES) is a poorly understood non-IgE-mediated food hypersensitivity, primarily affecting infants and toddlers. There are few data regarding pathophysiology of FPIES that suggest local intestinal imbalance between TNF-α and TGF-β. Patients frequently present with multiple reactions, which are characterized by projectile, repetitive emesis, dehydration, lethargy, and failure to thrive. Despite the severity of presentation, the diagnosis is frequently delayed, and patients often undergo extensive and invasive evaluation prior to reaching the diagnosis. RECENT FINDINGS Reviews published in the last year provide a general approach to diagnosis and management of FPIES and aim to increase awareness and understanding of FPIES among general pediatricians. SUMMARY Multicenter studies are necessary to reevaluate and modify the oral food challenge criteria. Research on the pathophysiology of FPIES reactions is necessary to provide insight into the evidence-based approach to diagnosis and management of FPIES. Registries are needed to understand the phenotype, triggers, and prevalence of FPIES.
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW The article discusses the clinical management of patients affected by food protein-induced enterocolitis syndrome (FPIES), focusing on established therapeutic choices and future options. RECENT FINDINGS After FPIES has been diagnosed and avoidance of the culprit food prescribed, the most important management needs are as follows. First, recurrence of acute FPIES episodes due to accidental ingestion of culprit food. It may be useful to give patients' families an action plan. The principal suggested treatments are intravenous fluids and steroids, whereas the use of epinephrine and ondansetron requires further study. In mild-to-moderate cases, oral rehydration should be sufficient. Second, dietary introduction of at-risk foods. In children with FPIES, in addition to that/those identified as culprit(s), some foods may not be tolerated (typically cow's milk, legumes, cereals, poultry). It has been suggested to avoid introducing these foods during the baby's first year. Otherwise, they may be given for the first time in hospital, performing an oral food challenge. Third, acquisition of tolerance. Children affected by cow's milk-FPIES have a good chance of acquiring tolerance by the time they reach age 18-24 months. For other culprit foods, insufficient data are available to indicate the appropriate time, so that it is suggested that an oral food challenge be performed about 1 year after the last acute episode. SUMMARY Future clinical management of FPIES must take into account, among other factors, improved understanding of pathogenesis, possible detection of different phenotypes, and the introduction of more effective therapies for acute episodes. These factors will undoubtedly influence management decisions, which will become more diversified and effective.
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW To summarize the latest information on the nutritional management of food protein-induced enterocolitis syndrome (FPIES), focusing on the foods implicated and how to avoid these whilst maintaining a nutritionally sound diet. RECENT FINDINGS A number of foods are implicated in FPIES such as milk, soy and grains, particularly rice. The number of foods implicated in FPIES per individual differs, but the majority of reported cases have two or fewer food triggers involved. SUMMARY FPIES is a complex presentation of non-IgE-mediated food allergy. Dietary management is complicated as both common food allergens as well as atypical food allergens can trigger FPIES. Sound nutritional advice is required to ensure appropriate food avoidance, adequate consumption of other foods and sufficient nutritional intake to maintain and ensure growth and development.
Collapse
|
41
|
Guibas GV, Tsabouri S, Makris M, Priftis KN. Food protein-induced enterocolitis syndrome: pitfalls in the diagnosis. Pediatr Allergy Immunol 2014; 25:622-9. [PMID: 24853552 DOI: 10.1111/pai.12237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/29/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) represents the severe end of the spectrum of gastrointestinal food hypersensitivity; its acute episodes can culminate in severe dehydration and hypovolemic shock, and its chronic form entails considerable morbidity associated with feeding difficulty and failure to thrive. Nevertheless, awareness for this syndrome remains rather low. Many factors hamper the establishment of FPIES diagnosis. Such factors pertain to the pathophysiological mechanism of the syndrome, causal food proteins, clinical manifestations, diagnostic procedures, differential diagnosis considerations, and prevailing perceptions which may require critical appraisal. Throughout this review, we will present and discuss these issues and put the focus on factors that could lead to under-diagnosis of FPIES, cause numerous acute episodes, and substantially increase the diseases morbidity and financial burden. We will also address other issues that are clinically relevant to FPIES.
Collapse
Affiliation(s)
- George V Guibas
- Allergy Research Laboratory, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, 'Attikon' General University Hospital, Athens, Greece
| | | | | | | |
Collapse
|
42
|
Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
43
|
Intraepithelial lymphocyte eotaxin-2 expression and perineural mast cell degranulation differentiate allergic/eosinophilic colitis from classic IBD. J Pediatr Gastroenterol Nutr 2014; 59:300-7. [PMID: 24813533 DOI: 10.1097/mpg.0000000000000432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Allergic colitis shows overlap with classic inflammatory bowel disease (IBD). Clinically, allergic colitis is associated with dysmotility and abdominal pain, and mucosal eosinophilia is characteristic. We thus aimed to characterise mucosal changes in children with allergic colitis compared with normal tissue and classic IBD, focusing on potential interaction between eosinophils and mast cells with enteric neurones. METHODS A total of 15 children with allergic colitis, 10 with Crohn disease (CD), 10 with ulcerative colitis (UC), and 10 histologically normal controls were studied. Mucosal biopsies were stained for CD3 T cells, Ki-67, eotaxin-1, and eotaxin-2. Eotaxin-2, IgE, and tryptase were localised compared with mucosal nerves, using neuronal markers neurofilament protein, neuron-specific enolase, and nerve growth factor receptor. RESULTS Overall inflammation was greater in patients with CD and UC than in patients with allergic colitis. CD3 T-cell density was increased in patients with allergic colitis, similar to that in patients with CD but lower than in patients with UC, whereas eosinophil density was higher than in all other groups. Eotaxin-1 and -2 were localised to basolateral crypt epithelium in all specimens, with eotaxin-1+ lamina propria cells found in all of the colitis groups. Eotaxin-2+ intraepithelial lymphocyte (IEL) density was significantly higher in allergic colitis specimens than in all other groups. Mast cell degranulation was strikingly increased in patients with allergic colitis (12/15) compared with that in patients with UC (1/10) and CD (0/1). Tryptase and IgE colocalised on enteric neurons in patients with allergic colitis but rarely in patients with IBD. CONCLUSIONS Eotaxin-2+ IELs may contribute to the periepithelial eosinophil accumulation characteristic of allergic colitis. The colocalisation of IgE and tryptase with mucosal enteric nerves is likely to promote the dysmotility and visceral hyperalgesia classically seen in allergic gastrointestinal inflammation.
Collapse
|
44
|
Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 545] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
Collapse
|
45
|
Darby A, Lertpiriyapong K, Sarkar U, Seneviratne U, Park DS, Gamazon ER, Batchelder C, Cheung C, Buckley EM, Taylor NS, Shen Z, Tannenbaum SR, Wishnok JS, Fox JG. Cytotoxic and pathogenic properties of Klebsiella oxytoca isolated from laboratory animals. PLoS One 2014; 9:e100542. [PMID: 25057966 PMCID: PMC4109914 DOI: 10.1371/journal.pone.0100542] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/28/2014] [Indexed: 02/06/2023] Open
Abstract
Klebsiella oxytoca is an opportunistic pathogen implicated in various clinical diseases in animals and humans. Studies suggest that in humans K. oxytoca exerts its pathogenicity in part through a cytotoxin. However, cytotoxin production in animal isolates of K. oxytoca and its pathogenic properties have not been characterized. Furthermore, neither the identity of the toxin nor a complete repertoire of genes involved in K. oxytoca pathogenesis have been fully elucidated. Here, we showed that several animal isolates of K. oxytoca, including the clinical isolates, produced secreted products in bacterial culture supernatant that display cytotoxicity on HEp-2 and HeLa cells, indicating the ability to produce cytotoxin. Cytotoxin production appears to be regulated by the environment, and soy based product was found to have a strong toxin induction property. The toxin was identified, by liquid chromatography-mass spectrometry and NMR spectroscopy, as low molecular weight heat labile benzodiazepine, tilivalline, previously shown to cause cytotoxicity in several cell lines, including mouse L1210 leukemic cells. Genome sequencing and analyses of a cytotoxin positive K. oxytoca strain isolated from an abscess of a mouse, identified genes previously shown to promote pathogenesis in other enteric bacterial pathogens including ecotin, several genes encoding for type IV and type VI secretion systems, and proteins that show sequence similarity to known bacterial toxins including cholera toxin. To our knowledge, these results demonstrate for the first time, that animal isolates of K. oxytoca, produces a cytotoxin, and that cytotoxin production is under strict environmental regulation. We also confirmed tilivalline as the cytotoxin present in animal K. oxytoca strains. These findings, along with the discovery of a repertoire of genes with virulence potential, provide important insights into the pathogenesis of K. oxytoca. As a novel diagnostic tool, tilivalline may serve as a biomarker for K oxytoca-induced cytotoxicity in humans and animals through detection in various samples from food to diseased samples using LC-MS/MS. Induction of K. oxytoca cytotoxin by consumption of soy may be in part involved in the pathogenesis of gastrointestinal disease.
Collapse
Affiliation(s)
- Alison Darby
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Kvin Lertpiriyapong
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Ujjal Sarkar
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge. Massachusetts, United States of America
| | - Uthpala Seneviratne
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge. Massachusetts, United States of America
| | - Danny S. Park
- Pharmaceutical Sciences and Pharmacogenomics Graduate Program, University of California, San Francisco, California, United States of America
| | - Eric R. Gamazon
- Section of Genetic Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Chara Batchelder
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Cheryl Cheung
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Ellen M. Buckley
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Nancy S. Taylor
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Zeli Shen
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Steven R. Tannenbaum
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge. Massachusetts, United States of America
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - John S. Wishnok
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge. Massachusetts, United States of America
| | - James G. Fox
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge. Massachusetts, United States of America
| |
Collapse
|
46
|
Ludman S, Harmon M, Whiting D, du Toit G. Clinical presentation and referral characteristics of food protein-induced enterocolitis syndrome in the United Kingdom. Ann Allergy Asthma Immunol 2014; 113:290-4. [PMID: 25065570 DOI: 10.1016/j.anai.2014.06.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 06/18/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a pediatric non-IgE-mediated allergic reaction to foods. The diagnosis of FPIES is clinical, with children presenting typically 2 to 4 hours after ingestion of a food protein. The most striking symptoms are vomiting, lethargy, and pallor. Misdiagnosis and delay in presentation to an allergist or gastroenterologist are common. OBJECTIVES To investigate the pathway of patients with FPIES presenting to a specialist clinic in the United Kingdom to ascertain whether they experienced delays or misdiagnoses and to investigate their symptoms and triggers. METHODS All patients with FPIES presenting over a 3-year period (2010-2013) in a tertiary pediatric allergy clinic in London were analyzed retrospectively. This was performed by searching electronically for all patients with a diagnosis of FPIES and manually reviewing paper notes. Presenting symptoms and management pathways were collated. RESULTS Fifty-four patients were identified, with an average age of onset at 8 months. They initially presented to medical professionals other than an allergist or gastroenterologist. The most frequent presenting symptom was vomiting followed by signs suggesting shock or hypotension and diarrhea. Differential diagnoses included gastroenteritis, sepsis, and surgical abnormalities. The main eliciting foods were cow's milk, fish, egg, soy, and wheat. CONCLUSION In the United Kingdom, FPIES typically has its onset at 8 months. Patients experience a delay of 12 months in the diagnosis of FPIES and frequently have multiple episodes and interim diagnoses. A great need remains for enhanced education of medical practitioners dealing with children about the varied presentations of FPIES.
Collapse
Affiliation(s)
- Siân Ludman
- Children's Allergy Service, St Thomas' Hospital, London, United Kingdom
| | - Mark Harmon
- Medical Student, Kings College Medical School, London, United Kingdom
| | - Danielle Whiting
- Medical Student, Kings College Medical School, London, United Kingdom
| | - George du Toit
- Children's Allergy Service, St Thomas' Hospital, London, United Kingdom.
| |
Collapse
|
47
|
Hwang JB. Is This Symptom Even a Food Allergy?: Clinical Types of Food Protein-induced Enterocolitis Syndrome. Pediatr Gastroenterol Hepatol Nutr 2014; 17:74-9. [PMID: 25061581 PMCID: PMC4107223 DOI: 10.5223/pghn.2014.17.2.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/01/2014] [Indexed: 11/14/2022] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized non-IgE-mediated gastrointestinal food allergy. The diagnosis of FPIES is based on clinical history, sequential symptoms and the timing, after excluding other possible causes. It is definitively diagnosed by an oral food challenge test. Unfortunately, the diagnosis of FPIES is frequently delayed because of non-specific symptoms and insufficient definitive diagnostic biomarkers. FPIES is not well recognized by clinicians; the affected infants are often mismanaged as having viral gastroenteritis, food poisoning, sepsis, or a surgical disease. Familiarity with the clinical features of FPIES and awareness of the indexes of suspicion for FPIES are important to diagnose FPIES. Understanding the recently defined clinical terms and types of FPIES is mandatory to suspect and correctly diagnose FPIES. The aim of this review is to provide a case-driven presentation as a guide of how to recognize the clinical features of FPIES to improve diagnosis and management of patients with FPIES.
Collapse
Affiliation(s)
- Jin-Bok Hwang
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW Because of the paucity of reports and variability in the diagnostic criteria utilized, little is known regarding the natural outcome of patients with food protein-induced enterocolitis syndrome (FPIES). Data extracted from referenced manuscripts, as well as allergists' unpublished observations from across the globe, were used to form a cohesive opinion regarding its natural outcome. RECENT FINDINGS All authors concur that there is a generally high rate of recovery for FPIES. The most common foods causing FPIES are milk and soy. Depending upon which study is analyzed, by the age of 3-5 years, approximately 90% of patients recover from their disease. Recovery from FPIES to solid foods, occurs at a later age, but may reflect a later stage of introduction of the food into the diet. An important clinical outcome, although not common, is a shift from FPIES food hypersensitivity to an IgE-mediated food allergy. This necessitates a change in the oral food challenge protocol, if IgE-mediated sensitization is detected. SUMMARY Over the past several years, there has been an increasing awareness of FPIES. This knowledge should lead to a more timely diagnosis and should reassure parents and practitioners alike regarding its favorable course.
Collapse
Affiliation(s)
- Yitzhak Katz
- aAllergy and Immunology Institute, Assaf Harofeh Medical Cente bDepartment of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
49
|
Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, Nowak-Węgrzyn A. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol 2014; 134:382-9. [PMID: 24880634 DOI: 10.1016/j.jaci.2014.04.008] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. FPIES diagnosis is frequently delayed because of the absence of classic allergic symptoms and lack of biomarkers. OBJECTIVE We sought to characterize the clinical features and resolution of FPIES in patients evaluated in our practice. METHODS Subjects 6 months to 45 years of age with FPIES were prospectively recruited for oral food challenges (OFCs). Medical records were searched to identify the subjects who did not participate in OFCs. RESULTS Among 160 subjects, 54% were male; median age at diagnosis was 15 months. We performed 180 OFCs to 15 foods in 82 subjects; 30% of the study population had FPIES confirmed based on OFC results. The most common foods were cow's milk (44%), soy (41%), rice (22.5%), and oat (16%). The majority (65%) reacted to 1 food, 26% reacted to 2 foods, and 9% reacted to 3 or more foods. The majority were atopic, and 39% had IgE sensitization to another food. Thirty-nine (24%) subjects had positive specific IgE levels to the food inducing FPIES. Among children with specific IgE to cow's milk, 41% changed from a milk FPIES to an IgE-mediated phenotype over time. The median age when tolerance was established was 4.7 years for rice, 4 years for oat, and 6.7 years for soy. Median age when milk tolerance was established for subjects with undetectable milk-specific IgE levels was 5.1 years, whereas none of the subjects with detectable milk-specific IgE became tolerant to milk during the study (P = .003). CONCLUSION FPIES typically resolves by age 5 years. Milk FPIES, especially with detectable food-specific IgE, can have a protracted course and eventually transition to acute reactions.
Collapse
Affiliation(s)
- Jean Christoph Caubet
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pediatric Allergy, University Hospital of Geneva, Geneva, Switzerland
| | - Lara Simone Ford
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Pediatrics & Child Health, Children's Hospital, Westmead, Australia
| | - Laura Sickles
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Jefferson Medical College, Philadelphia, Pa
| | - Kirsi M Järvinen
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Allergy and Immunology & Center for Immunology and Microbial Diseases, Albany Medical College, Albany, NY
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hugh A Sampson
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
50
|
Scaparrotta A, Di Pillo S, Consilvio NP, Attanasi M, Cingolani A, Rapino D, Cerasa M, Pucci N, Di Gioacchino M, Chiarelli F. Usefulness of Atopy Patch Test on a child with milk protein-induced enterocolitis syndrome: a case report. Int J Immunopathol Pharmacol 2014; 26:795-800. [PMID: 24067480 DOI: 10.1177/039463201302600327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a child affected by milk-protein induced enterocolitis, in which oral challenge with corn was performed without symptoms after a negative specific Atopy Patch Test. Food protein-induced enterocolitis syndrome (FPIES) is an uncommon nonIgE-mediated gastrointestinal food hypersensitivity of infancy, characterized by severe vomiting and diarrhea arising within 1 to 3 hours after ingestion of the causative food. Little is known about the pathophysiology of FPIES. The absence of food-specific IgE as demonstrated by negative skin prick tests suggests that the disease is not caused by an early onset IgE-mediated reaction. Atopy Patch Test has been described as sensitive and predictive in this syndrome. The hypothesis on the immunological pathogenesis has been discussed on the basis of literature data.
Collapse
Affiliation(s)
- A Scaparrotta
- Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|