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Kovaltchouk U, Gerstner T. Food protein-induced enterocolitis syndrome in an infant triggered by prunes. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:33. [PMID: 37088836 PMCID: PMC10123970 DOI: 10.1186/s13223-023-00787-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/01/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy that has a cumulative incidence of 0.015 to 0.7% in infants [1]. The most common allergens causing FPIES reactions include cow's milk, followed by soy, grains, and rice [1, 3]. Increasing clinical awareness of FPIES has resulted in the expansion of emerging triggers of FPIES, including fruit antigens. CASE PRESENTATION We describe an infant diagnosed with FPIES to prune. CONCLUSION Fruit allergens are an emerging group of triggers for FPIES, both in their fresh and dried forms. To our knowledge, this case is the first presentation of FPIES to prunes (dehydrated plum). This case highlights that careful history taking can avoid unnecessary investigations and delay in diagnosing FPIES.
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Affiliation(s)
- Uliana Kovaltchouk
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada.
| | - Thomas Gerstner
- Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Ponzi E, Maiorana A, Lepri FR, Mucciolo M, Semeraro M, Taurisano R, Olivieri G, Novelli A, Dionisi-Vici C. Persistent Hypoglycemia in Children: Targeted Gene Panel Improves the Diagnosis of Hypoglycemia Due to Inborn Errors of Metabolism. J Pediatr 2018; 202:272-278.e4. [PMID: 30193751 DOI: 10.1016/j.jpeds.2018.06.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/26/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the role of next generation sequencing in genetic diagnosis of pediatric patients with persistent hypoglycemia. STUDY DESIGN Sixty-four patients investigated through an extensive workup were divided in 3 diagnostic classes based on the likelihood of a genetic diagnosis: (1) single candidate gene (9/64); (2) multiple candidate genes (43/64); and (3) no candidate gene (12/64). Subsequently, patients were tested through a custom gene panel of 65 targeted genes, which included 5 disease categories: (1) hyperinsulinemic hypoglycemia, (2) fatty acid-oxidation defects and ketogenesis defects, (3) ketolysis defects, (4) glycogen storage diseases and other disorders of carbohydrate metabolism, and (5) mitochondrial disorders. Molecular data were compared with clinical and biochemical data. RESULTS A proven diagnosis was obtained in 78% of patients with suspicion for a single candidate gene, in 49% with multiple candidate genes, and in 33% with no candidate gene. The diagnostic yield was 48% for hyperinsulinemic hypoglycemia, 66% per fatty acid-oxidation and ketogenesis defects, 59% for glycogen storage diseases and other carbohydrate disorders, and 67% for mitochondrial disorders. CONCLUSIONS This approach provided a diagnosis in ~50% of patients in whom clinical and laboratory evaluation did not allow identification of a single candidate gene and a diagnosis was established in 33% of patients belonging to the no candidate gene class. Next generation sequencing technique is cost-effective compared with Sanger sequencing of multiple genes and represents a powerful tool for the diagnosis of inborn errors of metabolism presenting with persistent hypoglycemia.
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Affiliation(s)
- Emanuela Ponzi
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Romana Lepri
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mafalda Mucciolo
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michela Semeraro
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Roberta Taurisano
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giorgia Olivieri
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy; Unit of Child Neurology, Catholic University, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Unit, Medical Genetics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Rome, Italy.
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Moreno MV, Caparrós E, Fernández J, González-Delgado P. Immunologic study of two fruit-induced FPIES cases. Pediatr Allergy Immunol 2017; 28:713-715. [PMID: 28786506 DOI: 10.1111/pai.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Esther Caparrós
- Depto Medicina Clínica, Universidad Miguel Hernández, San Juan, Spain
| | - Javier Fernández
- Depto Medicina Clínica, Universidad Miguel Hernández, San Juan, Spain.,Servicio de Alergia, Hospital General de Alicante, Alicante, Spain
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Pecora V, Prencipe G, Valluzzi R, Dahdah L, Insalaco A, Cianferoni A, De Benedetti F, Fiocchi A. Inflammatory events during food protein-induced enterocolitis syndrome reactions. Pediatr Allergy Immunol 2017; 28:464-470. [PMID: 28375580 DOI: 10.1111/pai.12723] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND An increasing number of infants are diagnosed with food protein-induced enterocolitis syndrome (FPIES), a non-IgE-mediated food allergy. Until now, T-cell, food-specific mechanisms have been hypothesized. METHODS Sixteen children (11M, 5F), affected by FPIES from cow's milk, wheat, fruit, rice, and others, experienced 25 acute episodes managed at our emergency department (ED) and eight FPIES reactions during oral food challenges (OFC). We compared the laboratory data in resting conditions, in the absence of infectious diseases, with data collected during the 25 acute ED episodes (blood samples drawn at 2-12 hours) and the eight positive OFCs (three samples at 2, 6, and 12 hours). The onset of symptoms was used as a reference time point. RESULTS In basal conditions, total IgE, WBC, neutrophil and eosinophil count, CRP, and SGPT were found normal. LDH and SGOT values were high (627.81±97.88 and 45.75±10.26 UI/L, respectively). During ED reactions, LDH and SGOT increased to 794.21±247.28 (P=.028) and 51.08±16.99 UI/L (P=.14) and neutrophils count and CRP to 8.44±3.82×103 /μL (P=.0009) and 3.27±5.73 mg/dL (P=.0014), respectively. During positive OFC, LDH and SGOT did not vary significantly; CRP increased from 0.14±0.18 to 2.49±3.65 mg/dL (P=.00189) and neutrophil count from 2.79±1.42 to 7.10±3.98×103 /μL (P=.00096). CONCLUSIONS FPIES reactions are characterized by neutrophilia and by a time-dependent, significant increase in CRP, indicating that inflammatory mechanisms are in place. This suggests new directions for research on FPIES pathogenesis.
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Affiliation(s)
- Valentina Pecora
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Giusi Prencipe
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Rocco Valluzzi
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Lamia Dahdah
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonella Insalaco
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonella Cianferoni
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Alessandro Fiocchi
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Valadares ER, Cruz AFD, Adelino TER, Kanufre VDC, Ribeiro MDC, Penido MGMG, Peret Filho LA, Valadares LMSVE. Hereditary fructose intolerance in Brazilian patients. Mol Genet Metab Rep 2016; 4:35-8. [PMID: 26937407 PMCID: PMC4750570 DOI: 10.1016/j.ymgmr.2015.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/31/2015] [Accepted: 05/31/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Eugênia Ribeiro Valadares
- Ambulatório de Erros Inatos do Metabolismo do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil; Laboratório de Erros Inatos do Metabolismo do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil; Departamento de Propedêutica Complementar da Faculdade de Medicina da UFMG, Belo Horizonte, Brazil
| | - Ana Facury da Cruz
- Ambulatório de Erros Inatos do Metabolismo do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Viviane de Cássia Kanufre
- Ambulatório de Erros Inatos do Metabolismo do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Nowak-Węgrzyn A, Katz Y, Mehr SS, Koletzko S. Non-IgE-mediated gastrointestinal food allergy. J Allergy Clin Immunol 2015; 135:1114-24. [PMID: 25956013 DOI: 10.1016/j.jaci.2015.03.025] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/07/2023]
Abstract
Non-IgE-mediated gastrointestinal food-induced allergic disorders (non-IgE-GI-FAs) account for an unknown proportion of food allergies and include food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). Non-IgE-GI-FAs are separate clinical entities but have many overlapping clinical and histologic features among themselves and with eosinophilic gastroenteropathies. Over the past decade, FPIES has emerged as the most actively studied non-IgE-GI-FA, potentially because of acute and distinct clinical features. FPIAP remains among the common causes of rectal bleeding in infants, while classic infantile FPE is rarely diagnosed. The overall most common allergens are cow's milk and soy; in patients with FPIES, rice and oat are also common. The most prominent clinical features of FPIES are repetitive emesis, pallor, and lethargy; chronic FPIES can lead to failure to thrive. FPIAP manifests with bloody stools in well-appearing young breast-fed or formula-fed infants. Features of FPE are nonbloody diarrhea, malabsorption, protein-losing enteropathy, hypoalbuminemia, and failure to thrive. Non-IgE-GI-FAs have a favorable prognosis; the majority resolve by 1 year in patients with FPIAP, 1 to 3 years in patients with FPE, and 1 to 5 years in patients with FPIES, with significant differences regarding specific foods. There is an urgent need to better define the natural history of FPIES and the pathophysiology of non-IgE-GI-FAs to develop biomarkers and novel therapies.
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Affiliation(s)
- Anna Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Division of Pediatric Allergy, Mount Sinai School of Medicine, New York, NY.
| | - Yitzhak Katz
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sam Soheil Mehr
- Department of Allergy and Immunology, Children's Hospital at Westmead, Westmead, Australia
| | - Sibylle Koletzko
- Division of Gastroenterology and Hepatology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
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Abstract
Purpose of review To assess all the possible differential diagnosis of food protein-induced enterocolitis syndrome (FPIES), both in acute and chronic presentation, reviewing the data reported in published studies. Recent findings There is an increase of reported cases of FPIES in recent years. As the disease presents with nonspecific symptoms, it can be misunderstood in many ways. The differential diagnosis includes, in acute presentations, the following: sepsis, other infectious diseases, acute gastrointestinal episodes, surgical emergencies, food allergies. In its chronic forms, FPIES may mimic malabsorption syndromes, metabolic disorders, primary immunodeficiencies, neurological conditions, coagulation defects, and other types of non-IgE-mediated food allergy. Summary A thorough clinical evaluation, including symptoms, signs, and laboratory findings, is necessary to lead the clinicians toward the diagnosis of FPIES. The major reason for delayed diagnosis appears to be the lack of knowledge of the disease.
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