scholarly journals Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

2018 ◽  
Vol 73 (Suppl. 4) ◽  
pp. 8-16
Author(s):  
Christophe Dupont
Keyword(s):  
Good Prognosis ◽  
Cow’S Milk ◽  
Food Protein ◽  
Older Children ◽  
International Consensus ◽  
Cow's Milk ◽  
Breastfed Infants ◽  
Acute Form ◽  
Allergic Proctocolitis ◽  
International Consensus Guidelines

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.

scholarly journals FPIES in exclusively breastfed infants: two case reports and review of the literature

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Francesco Baldo ◽  
Martina Bevacqua ◽  
Cristiana Corrado ◽  
Daniela Nisticò ◽  
Laura Cesca ◽  
...  
Keyword(s):  
Amino Acid ◽  
Medical Literature ◽  
Challenge Test ◽  
Cow’S Milk ◽  
Diagnostic Process ◽  
Food Protein ◽  
Maternal Milk ◽  
Cow's Milk ◽  
Breastfed Infants ◽  
History Of

Abstract Background Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non IgE-mediated food allergy that generally affects children in the first year of life. Usually symptoms break out when formula milk or solid foods are introduced for the first time but they might also appear in exclusively breastfed infants, since the trigger elements, especially cow’s milk proteins, can be conveyed by maternal milk as well. FPIES in exclusively breastfed babies is a very rare clinical condition and only few cases have been reported in the medical literature. Case presentation We describe two cases of FPIES in exclusively breastfed babies. The first one is a two-month-old infant with a brief history of vomit and diarrhea that presented to the Emergency Department in septic-like conditions. The main laboratory finding was a significant increase in methemoglobin (13%). Clinically, we noted that, when breastfeeding was suspended, diarrhea drastically improved, and vice versa when maternal milk was reintroduced. An amino acid-based formula allowed a complete normalization of the symptoms. The second one is a three-month-old infant admitted for a 3 days history of persistent vomit and diarrhea. Blood tests showed a raised level of methemoglobin (7%). An esophagogastroduodenoscopy was performed and biopsies showed an eosinophilic infiltration of the duodenal mucosa. A maternal exclusion diet and an amino acid-based formula allowed a rapid regularization of the bowel function. Conclusions We searched all the cases of FPIES in exclusively breastfed babies reported in the medical literature, identifying eight patients, with an average age of 3 months (range 15 days – 6 months). The majority of the cases were initially diagnosed as gastroenteritis or sepsis, five cases were characterized by an acute on chronic scenario and cow’s milk was the most frequently involved food. Methemoglobin was never tested. An oral food challenge test was performed in two patients. FPIES in exclusively breastfed infants is a rare condition that, in the presence of compatible history and symptoms, should be considered also in exclusively breastfed babies. The evaluation of methemoglobin can simplify the diagnostic process.

scholarly journals FPIES: Reviewing the Management of Food Protein-Induced Enterocolitis Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Neha Khanna ◽  
Kirtika Patel
Keyword(s):  
Complex Form ◽  
Food Challenge ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk ◽  
Nutritional Advice ◽  
Management Plans ◽  
Acute Form ◽  
Ige Mediated ◽  
Hydrolysed Formula

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.

scholarly journals Food protein-induced enterocolitis syndrome: a large French multicentric experience

2021 ◽  
Author(s):  
Anaïs Lemoine ◽  
Anne-Sophie Colas ◽  
Sebastien LE ◽  
Christophe Delacourt ◽  
Patrick Tounian ◽  
...  
Keyword(s):  
Food Challenge ◽  
Good Prognosis ◽  
Food Protein ◽  
Consensus Guidelines ◽  
International Consensus ◽  
Hen’S Egg ◽  
Main Culprit ◽  
Ige Mediated ◽  
International Consensus Guidelines ◽  
French Cohort

Background Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated food allergy, with potential dehydration secondary to vomiting. Differences exist regarding culprit foods, onset symptoms, and age of tolerance depending on the country of origin. We aimed to describe the characteristics of a French population of children with FPIES. Methods Data from 179 children who were referred for acute or chronic FPIES in two pediatric tertiary centers between 2014 and 2020 were retrospectively collected. The diagnosis of FPIES was based on international consensus guidelines. Clinical characteristics, culprit food and age at resolution were assessed. Results In the 192 described FPIES, the age at first symptoms was 5.8 months old. The main offending foods were cow’s milk (60.3%), hen’s egg (16.2%), and fish (11.7%). Single FPIES was observed in 94.4% and multiple FPIES in 5.6% of cases. The age at resolution of FPIES was 2.2 years old, and resolution occurred later for fish than for milk (2.9 years versus 2.0, p=0.01). Severe acute FPIES was a risk factor for delayed resolution (relative risk: 3.3 [1.2-9.2]), but not IgE sensitization. Performing an oral food challenge within 12 months after the first reaction increased the risk of failure (RR: 2.0 [1.2-3.5]). Conclusion In this French cohort of children with FPIES, the main culprit foods were ubiquitous. Rice, oat and soy were rarely or not involved. Multiple FPIES was infrequent. Our data confirmed the overall good prognosis of FPIES, the later resolution of FPIES to fish and in the case of severe acute FPIES.

scholarly journals Humoral and cellular responses to casein in patients with food protein–induced enterocolitis to cow's milk

2017 ◽  
Vol 139 (2) ◽  
pp. 572-583 ◽  
Author(s):  
Jean Christoph Caubet ◽  
Ramon Bencharitiwong ◽  
Andrew Ross ◽  
Hugh A. Sampson ◽  
M. Cecilia Berin ◽  
...  
Keyword(s):  
Cellular Responses ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk

Cow’s milk substitutes

1983 ◽  
Vol 21 (24) ◽  
pp. 94.2-96
Keyword(s):  
Preschool Children ◽  
Breast Milk ◽  
Cow’S Milk ◽  
Older Children ◽  
Cow's Milk ◽  
Young Infants ◽  
Milk Substitutes

Cow’s milk is an important part of the diet in infants and preschool children. Breast milk is the most appropriate food for young infants, but when it is not available, or on the rare occasions when it is inappropriate, a feed based on cow’s milk is usually used. Sometimes, however, an infant needs a nutritionally complete formula feed based on something other than cow’s milk. Older children may likewise need a substitute for cow’s milk. This article discusses when such substitutes are needed and the merits of the different preparations.

Shift from IgE-mediated cow's milk allergy to food protein-induced enterocolitis syndrome in 2 infants

2018 ◽  
Vol 29 (4) ◽  
pp. 446-447 ◽  
Author(s):  
Simona Barni ◽  
Francesca Mori ◽  
Annamaria Bianchi ◽  
Neri Pucci ◽  
Elio Novembre
Keyword(s):  
Cow’S Milk Allergy ◽  
Cow’S Milk ◽  
Food Protein ◽  
Milk Allergy ◽  
Cow's Milk ◽  
Cow's Milk Allergy ◽  
Ige Mediated

International Consensus Guidelines for Diagnosis and Management of Food Protein-Induced Enterocolitis Syndrome

2015 ◽  
Vol 135 (2) ◽  
pp. AB279 ◽  
Author(s):  
Jonathan M. Spergel ◽  
Anna H. Nowak-Wegrzyn ◽  
Fallon Schultz ◽  
Marion E. Groetch ◽  
Marisa Conte ◽  
...  
Keyword(s):  
Food Protein ◽  
Consensus Guidelines ◽  
International Consensus ◽  
Diagnosis And Management ◽  
International Consensus Guidelines

scholarly journals Atypical Food protein-induced enterocolitis syndrome in children: Is IgE sensitization an issue longitudinally?

2021 ◽  
Vol 49 (3) ◽  
pp. 73-82
Author(s):  
Athina Papadopoulou ◽  
Theano Lagousi ◽  
Elpiniki Hatzopoulou ◽  
Paraskevi Korovessi ◽  
Stavroula Kostaridou ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Allergic Diseases ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk ◽  
T Helper 2 ◽  
Term Evaluation ◽  
Ige Mediated ◽  
Trigger Mechanisms

Background: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a clinically well-characterised, non-Immunoglobulin E (IgE)-mediated food allergy syndrome, yet its rare atypical presen-tation remains poorly understood.Objective: Aim of this study was to present the 10-year experience of a referral centre high-lighting the atypical FPIES cases and their long-term outcome.Methods: FPIES cases were prospectively evaluated longitudinally in respect of food outgrowth and developing other allergic diseases with or without concomitant IgE sensitisation.Results: One hundred subjects out of a total of 14,188 referrals (0.7%) were identified. At pre-sentation, 15 patients were found sensitised to the offending food. Fish was the most frequent eliciting food, followed by cow’s milk and egg. Tolerance acquisition was earlier for cow’s milk, followed by egg and fish, while found not to be protracted in atypical cases. Resolution was not achieved in half of the fish subjects during the 10-year follow-up time. Sensitisation to food was not related to infantile eczema or culprit food, but was related to sensitisation to aeroallergens. In the long-term evaluation, persistence of the FPIES or aeroallergen sensitisation was significantly associated with an increased hazard risk of developing early asthma symptoms. Conclusion: Sensitisation to food was related neither to eczema or culprit food nor to tolerance acquisition but rather to the development of allergic asthma through aeroallergen sen-sitisation. In addition to an IgE profile at an early age, FPIES persistence may also trigger mechanisms switching FPIES cases to a T-helper 2 cells immune response later in life, predis-posing to atopic respiratory symptoms; albeit further research is required.

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