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Hall H, Anvari S, Schultz F, Ojuola O, Rider NL. Delayed presentation of food protein-induced enterocolitis syndrome (FPIES) to okra in a toddler. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:9. [PMID: 38310247 PMCID: PMC10837919 DOI: 10.1186/s13223-024-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/01/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE) -mediated food allergy predominantly observed in infants and characterized by the delayed onset of vomiting following ingestion of a trigger food. An increase in research and clinical consideration of FPIES has led to the discovery of unique deviations from the standard FPIES triggers and presentations. CASE PRESENTATION A 34-month-old female patient with a history of consuming okra daily presented to medical attention after developing classic FPIES symptoms to okra beginning at 14-months of age. CONCLUSIONS Recently, awareness about the varied nature of FPIES clinical presentation has come to light. This case is the first to describe FPIES to the fruit okra that developed over a 12-month time span after previously tolerating the food. This case serves to emphasize the importance of understanding the range of FPIES symptoms to improve recognition and expedite best practice recommendations.
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Affiliation(s)
- Hunter Hall
- Department of Biology, Liberty University, Lynchburg, VA, USA
| | - Sara Anvari
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Fallon Schultz
- International FPIES Association, Point Pleasant Beach, NJ, USA
| | - Olubukola Ojuola
- Division of Pediatrics, Liberty University College of Osteopathic Medicine, Collaborative Health Partners, Lynchburg, VA, USA
| | - Nicholas L Rider
- Department of Health System & Implementation Science, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 249, Roanoke, Virginia, 24016, USA.
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2
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Rigg L, Kesavan A, Patel P. Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations. Clin Pediatr (Phila) 2023; 62:1580-1582. [PMID: 36927131 DOI: 10.1177/00099228231161326] [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: 03/18/2023]
Affiliation(s)
- Lauren Rigg
- Division of Allergy and Immunology, RUSH University Medical Center, Chicago, IL, USA
| | - Anil Kesavan
- Section of Pediatric Gastroenterology, RUSH University Children's Hospital, Chicago, IL, USA
| | - Payal Patel
- Division of Allergy and Immunology, RUSH University Medical Center, Chicago, IL, USA
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3
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Mulé A, Prattico C, Al Ali A, Mulé P, Ben-Shoshan M. Diagnostic and Management Strategies of Food Protein-Induced Enterocolitis Syndrome: Current Perspectives. Pediatric Health Med Ther 2023; 14:337-345. [PMID: 37901587 PMCID: PMC10612481 DOI: 10.2147/phmt.s404779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/13/2023] [Indexed: 10/31/2023] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a form of non-IgE mediated food allergy that presents with delayed gastrointestinal symptoms after ingestion of the trigger food. The data regarding FPIES are sparse, despite being recognized as a distinct clinical entity. This narrative review presents the characteristics of this disorder in the pediatric population, as well-standard diagnostic and management protocols. FPIES can be classified into acute and chronic subtypes, and some cases may develop into an IgE-mediated allergy. Given that skin prick tests and specific IgE levels are negative in the majority of cases, diagnosis relies on clinical history and oral food challenges. Management involves elimination diets, assessment of tolerance through oral food challenges, and rehydration in the event of a reaction. Future research should focus on improving diagnostic methods, illustrating underlying pathogenesis and biomarkers, and assessing long-term natural history. Increased knowledge and awareness for FPIES are required.
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Affiliation(s)
- Angela Mulé
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine Prattico
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Adnan Al Ali
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Pasquale Mulé
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
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4
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Hartono S, Zidan E, Sitaula P, Brooks JP. Pearls and pitfalls in food protein-induced enterocolitis syndrome (FPIES). Allergy Asthma Proc 2023; 44:368-373. [PMID: 37641223 PMCID: PMC10629436 DOI: 10.2500/aap.2023.44.230047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background: Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-immunoglobulin E (IgE) mediated gastrointestinal food hypersensitivity. It is a clinical diagnosis commonly characterized by profuse vomiting 1 to 4 hours after ingestion of the triggering food(s). Objective: The objective was to increase awareness of FPIES and review the epidemiology, clinical presentation, pathogenesis, diagnosis, and management of FPIES. The lack of availability of a definite biomarker or diagnostic tool often leads to a delay in diagnosis. Methods: A literature search of salient articles that described case reports and case series of FPIES and their management were analyzed. Results: A case of FPIES with a literature review is presented with emphasis on clinical pearls and pitfalls. FPIES is a diagnosis of exclusion and the mainstay of treatment is avoidance of the trigger food(s) for at least 12-18 months from the last exposure. Conclusion: As FPIES is a non-IgE-mediated reaction, allergy testing via skin-prick test or blood tests to measure food IgE antibodies is not routinely recommended. Many children outgrow FPIES by 3-4 years of age. Supervised oral food challenge is recommended to assess acquisition of tolerance.
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Affiliation(s)
- Stella Hartono
- From the Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Elena Zidan
- Department of Internal Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, Connecticut, and
| | - Prasiksha Sitaula
- Division of Pediatric Allergy, Immunology, and Rheumatology, Columbia University Irving Medical Center, New York, New York
| | - Joel P Brooks
- Division of Pediatric Allergy, Immunology, and Rheumatology, Columbia University Irving Medical Center, New York, New York
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5
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AL-Iede M, Sarhan L, Alshrouf MA, Said Y. Perspectives on Non-IgE-Mediated Gastrointestinal Food Allergy in Pediatrics: A Review of Current Evidence and Guidelines. J Asthma Allergy 2023; 16:279-291. [PMID: 36942164 PMCID: PMC10024490 DOI: 10.2147/jaa.s284825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/17/2023] [Indexed: 03/15/2023] Open
Abstract
Food allergy is an immune-mediated disease that can result in considerable morbidity and even mortality, with a significant negative impact on patients' quality of life. It is characterized by allergic symptoms that can occur shortly after a relevant food allergen ingestion, or can be delayed or chronic, which make it more difficult for diagnosis. The symptoms of this disease can range from mild to severe, and rarely can cause anaphylaxis, a life-threatening allergic reaction. The prevalence of non-immunoglobulin E (IgE)-mediated food allergy is poorly established outside of cow's milk allergy, with an adjusted incidence ranging between 0.13% and 0.72%. Several disorders are classified as non-immunoglobulin E (IgE)-mediated food allergies that predominantly affect the gastrointestinal tract including food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), food protein-induced allergic enteropathy (FPE), and food protein-induced dysmotility disorders (GORD and constipation). Eosinophilic esophagitis (EoE) is listed in this group, even though it considered by some authorities to be mixed reaction with both IgE and cell-mediated immune response to be involved in the reaction. The most common types of non-IgE-mediated food allergy are food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). These disorders typically present in infancy and are often triggered by cow's milk protein. Patients with FPIES present with profuse emesis and dehydration, while FPIAP patients present with hematochezia in otherwise healthy infants. Since there are no specific confirmatory non-invasive diagnostic laboratory tests, the diagnosis is usually made clinically when typical symptoms improve upon the removal of the culprit food. Food reintroduction should be attempted, when possible, with documentation of symptoms of relapse to confirm the diagnosis. The management includes dietary avoidance, supportive treatment in the case of accidental exposure, and nutritional counseling. This review focuses on the clinical manifestations, epidemiology, management, and recent guidelines of the most common non-IgE-mediated food hypersensitivity disorders (FPIES, FPIAP, and FPE).
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Affiliation(s)
- Montaha AL-Iede
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Jordan University Hospital, Amman, Jordan
- Correspondence: Montaha AL-Iede, Division of Pediatric Pulmonology and Sleep Medicine, The University of Jordan, Queen Rania Street, Amman, 11972, Jordan, Tel + 962 65355000, Email ;
| | - Lena Sarhan
- Department of Pediatrics, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad A Alshrouf
- Department of Pediatrics, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan
| | - Yazan Said
- Division of Allergy, Immunology, and pulmonology, Department of Pediatrics, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Nagashima K, Fujii N, Oka S, Yamashita A, Itagaki F, Yasuno N, Watanabe M, Kishimoto S. Peptides Derived from Soybean β-Conglycinin Induce the Migration of Human Peripheral Polymorphonuclear Leukocytes. Biol Pharm Bull 2023; 46:898-906. [PMID: 37394641 DOI: 10.1248/bpb.b23-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Food-derived peptides have various biological activities. When food proteins are ingested orally, they are digested into peptides by endogenous digestive enzymes and absorbed by the immune cell-rich intestinal tract. However, little is known about the effects of food-derived peptides on the motility of human immune cells. In this study, we aimed to understand the effects of peptides derived from a soybean protein β-conglycinin on the motility of human peripheral polymorphonuclear leukocytes. We illustrated that MITL and MITLAIPVNKPGR, produced by digestion using in-vivo enzymes (trypsin and pancreatic elastase) of β-conglycinin, induces the migration of dibutyryl cAMP (Bt2 cAMP)-differentiated human promyelocytic leukemia 60 (HL-60) cells and human polymorphonuclear leukocytes in a dose- and time-dependent manner. This migration was more pronounced in Bt2 cAMP-differentiated HL-60 cells; mRNA expression of formyl peptide receptor (FPR) 1 increased significantly than in all-trans-retinoic acid (ATRA)-differentiated HL-60 cells. This migration was inhibited by tert-butoxycarbonyl (Boc)-MLP, an inhibitor of FPR, and by pretreatment with pertussis toxin (PTX). However, the effect was weak when treated with WRW4, a selective inhibitor of the FPR2. We then demonstrated that MITLAIPVNKPGR induced intracellular calcium responses in human polymorphonuclear leukocytes and Bt2 cAMP-HL60 cells. Furthermore, pre-treatment by fMLP desensitized the calcium response of MITLAIPVNKPGR in these cells. From the above, MITLAIPVNKPGR and MITL derived from soybean β-conglycinin induced polymorphonuclear leukocyte migration via the FPR1-dependent mechanism. We found chemotactic peptides to human polymorphonuclear leukocytes, which are the endogenous enzyme digests of soybean protein.
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Affiliation(s)
- Kazuki Nagashima
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Sciences, Teikyo University
| | | | - Saori Oka
- Laboratory of Molecular Health Science, Faculty of Pharma-Sciences, Teikyo University
| | - Atsushi Yamashita
- Laboratory of Biological Chemistry, Faculty of Pharma-Sciences, Teikyo University
| | - Fumio Itagaki
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Sciences, Teikyo University
| | - Nobuhiro Yasuno
- Laboratory of Hospital Pharmacy, Faculty of Pharma-Science, Teikyo University
| | - Machiko Watanabe
- Laboratory of Clinical Pharmaceutics, Faculty of Pharma-Sciences, Teikyo University
| | - Seishi Kishimoto
- Radioisotope Research Center, Teikyo University
- Research Center for Pharmaceutical Education, Faculty of Pharma-Sciences, Teikyo University
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7
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Abril AG, Villa TG, Sánchez-Pérez Á, Notario V, Carrera M. The Role of the Gallbladder, the Intestinal Barrier and the Gut Microbiota in the Development of Food Allergies and Other Disorders. Int J Mol Sci 2022; 23:ijms232214333. [PMID: 36430811 PMCID: PMC9696009 DOI: 10.3390/ijms232214333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/03/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
The microbiota present in the gastrointestinal tract is involved in the development or prevention of food allergies and autoimmune disorders; these bacteria can enter the gallbladder and, depending on the species involved, can either be benign or cause significant diseases. Occlusion of the gallbladder, usually due to the presence of calculi blocking the bile duct, facilitates microbial infection and inflammation, which can be serious enough to require life-saving surgery. In addition, the biliary salts are secreted into the intestine and can affect the gut microbiota. The interaction between the gut microbiota, pathogenic organisms, and the human immune system can create intestinal dysbiosis, generating a variety of syndromes including the development of food allergies and autoimmune disorders. The intestinal microbiota can aggravate certain food allergies, which become severe when the integrity of the intestinal barrier is affected, allowing bacteria, or their metabolites, to cross the intestinal barrier and invade the bloodstream, affecting distal body organs. This article deals with health conditions and severe diseases that are either influenced by the gut flora or caused by gallbladder obstruction and inflammation, as well as putative treatments for those illnesses.
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Affiliation(s)
- Ana G. Abril
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
| | - Tomás G. Villa
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Ángeles Sánchez-Pérez
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia
| | - Vicente Notario
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mónica Carrera
- Department of Food Technology, Spanish National Research Council, Marine Research Institute, 36208 Vigo, Spain
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8
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Hernández‐Almeida P, Vásconez‐Muñoz F, Vásconez‐Montalvo A, Sempértegui‐Moscoso R, Contreras G, Carrión‐Jaramillo E. Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review. Clin Case Rep 2022; 10:e6520. [DOI: 10.1002/ccr3.6520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/25/2022] [Accepted: 10/09/2022] [Indexed: 11/25/2022] Open
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9
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Li M, Fang Y, Lian Y, Lu X, Qiu M, He Y. Effect of hydrolyzed formulas on gastrointestinal tolerance in preterm infants: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:10173-10180. [DOI: 10.1080/14767058.2022.2122794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Mengyuan Li
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yuehui Fang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yiyao Lian
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Xiaodi Lu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Meijuan Qiu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yuna He
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
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10
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Wong S, Duan L, Galper A, Atkinson A, Upton J, Eiwegger T. Food protein-induced enterocolitis syndrome in a tertiary pediatric center: safety of guideline-conforming food challenges. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:54. [PMID: 35710451 PMCID: PMC9202320 DOI: 10.1186/s13223-022-00694-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Food protein-induced enterocolitis syndrome is a non-IgE-mediated reaction to food that is poorly understood, and underdiagnosed. Trigger foods can belong to any food group, but are most commonly milk, soy, rice, oat, egg, and fish. In this retrospective study (2015–2020), we describe the clinical presentations and triggers of 37 children referred to tertiary hospital with a confirmed or suspected diagnosis of food protein-inducted enterocolitis. We reviewed the safety of current recommendations by looking at the outcome of 24 oral food challenges. All of these patients presented with clear cut systemic reactions including lethargy. We also assessed the severity of the reactions. Oral food challenges occurred in the hospital day unit with the majority of patients having IV access in place. Despite a clear history of FPIES with lethargy and the requirement for re-hydration of the challenged population, 21/24 (88%) of the FPIES OFCs were successful. Of the three patients who reacted, symptoms were of moderate nature, mainly vomiting. This highlights the importance of early diagnosis and a pro-active approach to performing guideline-directed oral food challenges in patients with food protein-induced enterocolitis syndrome.
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Affiliation(s)
- Samantha Wong
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lucy Duan
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Alana Galper
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Adelle Atkinson
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Canada. .,Department of Immunology, University of Toronto, Toronto, Canada. .,Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Austria. .,Karl Landsteiner University of Health Sciences, Krems, Austria.
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11
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Sultafa J, McKibbon L, Roberts H, Sarraj J, Kim H. Modified oral food challenge protocol approach in the diagnosis of Food Protein-Induced Enterocolitis Syndrome. Allergy Asthma Clin Immunol 2022; 18:8. [PMID: 35101093 PMCID: PMC8805409 DOI: 10.1186/s13223-022-00651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE mediated food allergy most commonly presenting in infants. The most common food triggers include soy, cow’s milk and grains. Symptoms may include intractable vomiting, diarrhea, lethargy, pallor, abdominal distention, hypotension and/or shock. Oral food challenges (OFCs) given at food protein dose of 0.06–0.6 g/kg in 3 equivalent doses administered over a few hours are recommended in guidelines to confirm a diagnosis. Case presentation The patient is a 6-month-old girl with a history of severe FPIES symptoms to egg. In our clinic, we perform OFC with 1/100 serving dose on visit 1 and then increase the dose monthly. The patient takes the tolerated dose daily at home between visits. An OFC to baked egg at 1/100 of a serving was performed and was well-tolerated on her initial visit. The patient remained on the same dose upon returning home. Within 1-week, she developed FPIES symptoms including watery diarrhea and severe emesis requiring ondansetron. She required an Emergency Department visit for one of the reactions. Conclusions Our patient had severe FPIES symptoms with a small amount of egg. We believe that administration of three large food challenge doses on one clinic visit, as guidelines currently suggest, does not allow adequate time for symptoms to appear. Our patient likely would have suffered a severe reaction. Also, this guidelines protocol does not allow for monitoring of more delayed or chronic FPIES. We propose a modified protocol to OFCs with cautious up-dosing to allow for safer OFCs and monitoring of chronic FPIES. We have implemented an OFC approach where only one food challenge dose (starting with 1/100 of final dose) is given at each visit. The up-titration of the dose is completed every 4-weeks with one dose only. When the serving sized dose is reached and tolerated, the food can be maintained in the diet.
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12
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D’Auria E, Salvatore S, Acunzo M, Peroni D, Pendezza E, Di Profio E, Fiore G, Zuccotti GV, Verduci E. Hydrolysed Formulas in the Management of Cow's Milk Allergy: New Insights, Pitfalls and Tips. Nutrients 2021; 13:2762. [PMID: 34444922 PMCID: PMC8401609 DOI: 10.3390/nu13082762] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
An allergy to cow's milk requires the avoidance of cow's milk proteins and, in some infants, the use of a hypoallergenic formula. This review aims to summarize the current evidence concerning different types of hydrolysed formulas (HF), and recommendations for the treatment of IgE- and non-IgE-mediated cow's milk allergy and functional gastrointestinal disorders in infancy, for which some dietary intervention and HF may be of benefit to both immune and motor mechanisms. Current guidelines recommend cow's milk protein (i.e., whey or casein) extensively hydrolysed formula (eHF) as the first choice for cow's milk allergy treatment, and amino acid formulas for more severe cases or those with reactions to eHF. Rice hydrolysed formulas (rHF) have also become available in recent years. Both eHF and rHF are well tolerated by the majority of children allergic to cow's milk, with no concerns regarding body growth or adverse effects. Some hydrolysates may have a pro-active effect in modulating the immune system due to the presence of small peptides and additional components, like biotics. Despite encouraging results on tolerance acquisition, evidence is still not conclusive, thus hampering our ability to draw firm conclusions. In clinical practice, the choice of hypoallergenic formula should be based on the infant's age, the severity, frequency and persistence of symptoms, immune phenotype, growth pattern, formula cost, and in vivo proof of tolerance and efficacy.
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Affiliation(s)
- Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Silvia Salvatore
- Department of Pediatrics, Ospedale “F. Del Ponte”, University of Insubria, 21100 Varese, Italy;
| | - Miriam Acunzo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy;
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Elisabetta Di Profio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Giulia Fiore
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (M.A.); (E.P.); (E.D.P.); (G.F.); (G.V.Z.); (E.V.)
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13
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Sangild PT, Vonderohe C, Melendez Hebib V, Burrin DG. Potential Benefits of Bovine Colostrum in Pediatric Nutrition and Health. Nutrients 2021; 13:nu13082551. [PMID: 34444709 PMCID: PMC8402036 DOI: 10.3390/nu13082551] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
Bovine colostrum (BC), the first milk produced from cows after parturition, is increasingly used as a nutritional supplement to promote gut function and health in other species, including humans. The high levels of whey and casein proteins, immunoglobulins (Igs), and other milk bioactives in BC are adapted to meet the needs of newborn calves. However, BC supplementation may improve health outcomes across other species, especially when immune and gut functions are immature in early life. We provide a review of BC composition and its effects in infants and children in health and selected diseases (diarrhea, infection, growth-failure, preterm birth, necrotizing enterocolitis (NEC), short-bowel syndrome, and mucositis). Human trials and animal studies (mainly in piglets) are reviewed to assess the scientific evidence of whether BC is a safe and effective antimicrobial and immunomodulatory nutritional supplement that reduces clinical complications related to preterm birth, infections, and gut disorders. Studies in infants and animals suggest that BC should be supplemented at an optimal age, time, and level to be both safe and effective. Exclusive BC feeding is not recommended for infants because of nutritional imbalances relative to human milk. On the other hand, adverse effects, including allergies and intolerance, appear unlikely when BC is provided as a supplement within normal nutrition guidelines for infants and children. Larger clinical trials in infant populations are needed to provide more evidence of health benefits when patients are supplemented with BC in addition to human milk or formula. Igs and other bioactive factors in BC may work in synergy, making it critical to preserve bioactivity with gentle processing and pasteurization methods. BC has the potential to become a safe and effective nutritional supplement for several pediatric subpopulations.
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Affiliation(s)
- Per Torp Sangild
- Comparative Pediatrics & Nutrition, University of Copenhagen, DK-1870 Copenhagen, Denmark;
- Department of Neonatology, Rigshospitalet, DK-1870 Copenhagen, Denmark
- Department of Pediatrics, Odense University Hospital, DK-5000 Odense, Denmark
| | - Caitlin Vonderohe
- USDA-ARS Children’s Nutrition Research Center, Pediatrics, Gastroenterology & Nutrition, Baylor College of Medicine, Houston, TX 77030, USA; (C.V.); (V.M.H.)
| | - Valeria Melendez Hebib
- USDA-ARS Children’s Nutrition Research Center, Pediatrics, Gastroenterology & Nutrition, Baylor College of Medicine, Houston, TX 77030, USA; (C.V.); (V.M.H.)
| | - Douglas G. Burrin
- USDA-ARS Children’s Nutrition Research Center, Pediatrics, Gastroenterology & Nutrition, Baylor College of Medicine, Houston, TX 77030, USA; (C.V.); (V.M.H.)
- Correspondence: ; Tel.: +1-713-798-7049
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Bawazir R, Bawazir O, Bawazir A. Food protein-induced enterocolitis mimics surgical emergency in a neonate: A case report. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Bouvette G, Verreault N, Gagnon N, Lavoie A. Drug-induced enterocolitis syndrome (DIES) with pantoprazole in an adult patient. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:3183-3184. [PMID: 32376488 DOI: 10.1016/j.jaip.2020.04.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Geneviève Bouvette
- Division of Internal Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
| | - Nina Verreault
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université Laval (CHUL), Quebec, QC, Canada
| | - Nathalie Gagnon
- Division of Internal Medicine, Department of Medicine, Hôpital Saint-François d'Assise (HSFA), Quebec, QC, Canada
| | - Aubert Lavoie
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université Laval (CHUL), Quebec, QC, Canada
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Mastrorilli C, Santoro A, Procaccianti M, Pagliaro G, Caffarelli C. New insights into food protein-induced enterocolitis in children. Minerva Pediatr 2020; 72:416-423. [PMID: 32686925 DOI: 10.23736/s0026-4946.20.05976-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) represents a non-IgE-mediated food allergic disorder with delayed gastrointestinal symptoms that may evolve in a medical emergency. Clinically, FPIES can be distinguished into acute and chronic phenotypes. FPIES is mainly diagnosed in infancy however the onset at older ages is being progressively described. The pathogenetic mechanism underlying FPIES remains mainly unexplained, but an alteration of food-specific T-cell response has been proposed. The diagnosis of FPIES is primarily clinical, since there are not available specific biomarkers. Oral food challenge (OFC) is the gold standard for diagnosing FPIES or excluding the onset of tolerance to the triggering food. Management of FPIES includes an acute phase treatment and a maintenance therapy with the strict food avoidance until challenge, in order to prevent new attacks and avoid nutritional alterations. Acute management requires hydration that can be performed orally or intravenously according to clinical status. Long-term management of FPIES is based on the avoidance of the culprit food(s) and supervised introduction of other high-risk foods if never taken before among infants before 12 months of age. There is a compelling need of future achievements in FPIES research for the definition of underlying disease pathogenesis and potential therapeutic point of care.
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Affiliation(s)
- Carla Mastrorilli
- Unit of Pediatric Allergy and Pulmonology, Department of Pediatrics and Emergency, Consorziale-Policlinico University Hospital, Pediatric Hospital Giovanni XXIII, Bari, Italy -
| | - Angelica Santoro
- Department of Medicine and Surgery, Pediatric Clinic, University of Parma, Parma, Italy
| | - Michela Procaccianti
- Department of Medicine and Surgery, Pediatric Clinic, University of Parma, Parma, Italy
| | - Giuseppe Pagliaro
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Carlo Caffarelli
- Department of Medicine and Surgery, Pediatric Clinic, University of Parma, Parma, Italy
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Pérez Ajami RI, Carrión Sari SK, Aliaga Mazas Y, Calvo JB, Guallar Abadía MI. Experience in food protein-induced enterocolitis syndrome in a paediatric allergy clinic. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Barni S, Liotti L, Mori F, Liccioli G, Pucci N, Novembre E. Are oral food challenges for introduction of high-risk foods in children with food protein-induced enterocolitis syndrome needed? Pediatr Allergy Immunol 2020; 31:326-329. [PMID: 31765506 DOI: 10.1111/pai.13180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Lucia Liotti
- Pediatric Unit, Hospital of Senigallia, Senigallia, Italy
| | | | | | - Neri Pucci
- Meyer Children's Hospital, Florence, Italy
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Pérez Ajami RI, Carrión Sari SK, Aliaga Mazas Y, Calvo JB, Guallar Abadía MI. [Experience in food protein-induced enterocolitis syndrome in a paediatric allergy clinic]. An Pediatr (Barc) 2020; 92:345-350. [PMID: 32127302 DOI: 10.1016/j.anpedi.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Food Protein-Induced Enterocolitis Syndrome (FPIES) is a gastrointestinal syndrome due to a non-IgE mediated food hypersensitivity.. The most common triggers are cow's milk and soy. Fish is one of the most frequently reported causes in Spain. The objective of this study is to describe the clinical characteristics of patients diagnosed with (FPIES) in a Paediatric Allergy Clinic. MATERIAL AND METHODS A retrospective descriptive study was carried out by reviewing medical records of patients diagnosed with FPIES in the Paediatric Allergy Unit of the Miguel Servet Children's Hospital from the years 2007 to 2017. RESULTS A total of 135 patients were diagnosed during the study period, of whom 45% were male and 55% were female. The mean age at diagnosis was 11±1.5 months and the mean age of improvement was 2 years and 6 months±2.5 years (n=83). A personal history of atopy was observed in 31.9%. The main trigger foods were: white fish (41.4%), cow's milk (25.1%), and egg (15.5%). A conversion to IgE-mediated allergy was seen in 4.4% of patients. There was vomiting in 81.5% of the cases, with a mean of 1.75±1.1hours of latency, as well as diarrhoea in 41.5%, with a mean of 7.86±15.16hours of latency, and decline in 30.4% with a mean latency of 3.81±11.57hours. DISCUSSION In our series, the most frequent trigger of the FPIES was fish. It was manifested mainly by late vomiting and a tolerance was reached mostly at 2 years 6 months.
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Presentation and Management of Food Allergy in Breastfed Infants and Risks of Maternal Elimination Diets. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:52-67. [DOI: 10.1016/j.jaip.2019.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
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Callegari A, Tharakan SJ, Christmann M. Non–IgE-mediated gastrointestinal food-induced allergic disorders can mimic necrotizing enterocolitis in neonates with congenital heart diseases with left-ventricular outflow tract obstruction. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bosa L, Martelossi S, Tardini G, Midrio P, Lago P. Early onset food protein-induced enterocolitis syndrome in two breastfed newborns masquerading as surgical diseases: case reports and literature review. J Matern Fetal Neonatal Med 2019; 34:390-394. [PMID: 30983441 DOI: 10.1080/14767058.2019.1608435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E cell-mediated gastrointestinal food allergy that primarily presents in infancy, as early as the first hours of life. FPIES is often misdiagnosed as sepsis, severe gastroenteritis, abdominal surgical emergency or even metabolic, neurologic, or cardiac disorders.Methods: We report two neonatal cases of cow's milk protein (CMP)-induced FPIES masquerading as surgical diseases. Our purpose is to highlight the diagnostic difficulties in FPIES in this age group and to provide further evidence of the important role played by the prenatal environment in the development of allergic diseases.Results: Case 1 is a 2-day-old boy born at 35th + 5 weeks of gestation admitted to our Neonatal Intensive Care Unit (NICU) for bloody diarrhea who started presenting apnea, crying, pallor, jaundice, and abdominal tenderness. Case 2 is a 3-day-old boy born at 38th +5 weeks of gestation admitted to our NICU for repeated bilious vomiting. Both patients were administered infant formula in the first hours of life, thereafter they received only breast milk. In both cases, CMP allergy was finally suspected and an extensively hydrolyzed formula was administered with the resolution of symptoms. A diagnosis of CMP-induced FPIES was made.Conclusions: FPIES is a heterogeneous disorder. Severe forms of FPIES could be mistaken for surgical diseases, such as necrotizing enterocolitis. A trial of food elimination should be considered whenever diagnostic tests are inconclusive. FPIES must be suspected even in breastfed infants.
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Affiliation(s)
- Luca Bosa
- Department of Woman's and Child's Health, Università degli Studi di Padova, Padova, Italy
| | | | - Giacomo Tardini
- Department of Woman's and Child's Health, Università degli Studi di Padova, Padova, Italy
| | - Paola Midrio
- Pediatric Surgery Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Paola Lago
- Neonatal Intensive Care Unit, Ca' Foncello Hospital, Treviso, Italy
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Ravanbakhsh N, Kesavan A. The role of mast cells in pediatric gastrointestinal disease. Ann Gastroenterol 2019; 32:338-345. [PMID: 31263355 PMCID: PMC6595934 DOI: 10.20524/aog.2019.0378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
Mast cells are granulocytes derived from CD34+ pluripotent progenitor cells that demonstrate plasticity in their development, leaving the bone marrow and differentiating in the tissue where they ultimately reside. They are best known for their role in the allergic response, but also play a prominent immunoregulatory role in other processes, including immune tolerance, the innate immune response, angiogenesis, wound healing and tissue remodeling. Mast cells are found throughout the gastrointestinal tract; their metabolic products influence and regulate intestinal epithelial and endothelial function, gastrointestinal secretion, intestinal motility and absorption, and contribute to host defense. They also play an important role in the development of visceral hypersensitivity through bidirectional interaction with the enteric nervous system. Mast cells have been found to have an increasingly important role in the pathophysiology of a number of pediatric gastrointestinal diseases. This review summarizes the current understanding of the role that mast cells play in the development of pediatric gastrointestinal disorders, including eosinophilic esophagitis, functional dyspepsia, irritable bowel syndrome, celiac disease, inflammatory bowel disease, histologically negative appendicitis, Hirschsprung’s disease, intestinal neuronal dysplasia, and food protein-induced enterocolitis syndrome.
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Affiliation(s)
| | - Anil Kesavan
- Section of Pediatric Gastroenterology (Anil Kesavan), Rush University Children's Hospital, Chicago, IL, USA
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Severity scales of non-IgE-mediated gastrointestinal food allergies in neonates and infants. Allergol Int 2019; 68:178-184. [PMID: 30253946 DOI: 10.1016/j.alit.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/25/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Non-IgE-mediated gastrointestinal food allergies (non-IgE-GI-FAs) are one type of food allergy found in neonates and infants. Few reports have defined the severity of non-IgE-GI-FAs in these populations. METHODS Grading scales of the severity of non-IgE-GI-FAs according to extra-GI symptoms, such as poor weight gain, as well as systemic symptoms, including fever and shock, were developed and retrospectively applied to patients with non-IgE-GI-FAs. The relationship between the severity of non-IgE-GI-FAs and both clinical and laboratory findings were examined. RESULTS Elevation of C-reactive protein levels and a decrease in total protein and albumin were observed in accordance with allergy severity. In an endoscopic examination, inflammatory findings were confirmed in large areas of the colonic mucosa in case of higher severity levels, and infiltration of inflammatory cells other than eosinophils was found in the severest grade. Extensively hydrolyzed milk or amino acid-based milk was required for all patients with the severest grade. In addition, the timing of acquiring tolerance tended to be late for this grade. CONCLUSIONS Classification and determination of the severity of non-IgE-GI-FAs in neonates and infants may not only contribute to elucidation of the pathogenesis but may also be useful in the clinical setting.
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Dupont C. Food Protein-Induced Enterocolitis Syndrome and Proctocolitis. ANNALS OF NUTRITION AND METABOLISM 2019. [DOI: 10.1159/000493671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Non-IgE-mediated, also labeled cell-mediated, allergic reactions to foods are more common than usually thought and probably account for approximately more than 40% of cases of cow’s milk allergy during infancy and young childhood. Food allergy is now described in the form of syndromes, among which food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP) are gaining increased recognition. FPIES occurs in infancy but may also occur in older children and in adults. The dominant symptom is emesis, repetitive in the chronic FPIES form and explosive in the acute form. Acute FPIES begins 1– 4 h following ingestion of the offending food. Diarrhea is frequent, between 5 and 10 h later, and may be accompanied by lethargy and dehydration, which both characterize severity. Cow’s milk is the most frequent food trigger, followed by soy. FPIES may develop up to 1 year of age, but may also occur in the newborn, and is possible in exclusively breastfed infants, in relation with the mother’s consumption of offending foods. FPIES may occur to solid foods (grains like rice or oat, meats, fish, egg, and vegetables). When starting during infancy, FPIES has a good prognosis and disappears grossly at 2 years of age. FPIES to fish or shellfish is more frequent in older children and adults and is long lasting. International consensus guidelines for the diagnosis and management of FPIES have been published recently. FPIAP starts in the first few months of life and is typically manifested with rectal bleeding in well-appearing breastfed infants during the first months of life in reaction to cow’s milk consumed by the mother. The condition is transient but represents one of the major causes of colitis during infancy.
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Salloum S. A 4-month-old girl with hematemesis, pallor, and lethargy. Paediatr Child Health 2019; 24:5-6. [DOI: 10.1093/pch/pxy042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shafee Salloum
- Dayton Children’s Hospital - Pediatric Hospital Medicine, Dayton, Ohio, USA
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Van Thuijl AOJ, Landzaat LJ, Liem O, Emons JAM, Arends NJT. Drug-induced enterocolitis syndrome (DIES): A clinical entity that deserves more awareness. Ann Allergy Asthma Immunol 2019; 122:538-539. [PMID: 30772389 DOI: 10.1016/j.anai.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Anders O J Van Thuijl
- Reinier de Graaf Gasthuis, Department of Pediatric Allergology, Delft, The Netherlands
| | - Lonneke J Landzaat
- Erasmus MC University Medical Center, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Rotterdam, The Netherlands
| | - Olivia Liem
- Erasmus MC University Medical Center, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Rotterdam, The Netherlands
| | - Joyce A M Emons
- Erasmus MC University Medical Center, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Rotterdam, The Netherlands
| | - Nicolette J T Arends
- Erasmus MC University Medical Center, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Rotterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW We focus on recent advances regarding the epidemiology, physiopathology, diagnosis and managements of non-IgE-mediated gastrointestinal food allergies (non-IgE-GI-FAs), particularly food protein-induced enterocolitis syndrome (FPIES). RECENT FINDINGS The first international FPIES diagnostic and management guidelines have been recently published. Although FPIES largely remains a diagnosis of exclusion, it may be more prevalent than previously thought. Ondansetron has emerged as a major tool for the treatment of FPIES acute reactions. Recent data also suggest an important role for innate immune cells in FPIES pathogenesis. SUMMARY Despite major advances in the diagnosis and management of non-IgE-GI-FAs, particularly FPIES, the lack of specific diagnostic tests and biomarkers to guide clinical management remains challenging.
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