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

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.

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Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions

Medicina ◽

10.3390/medicina55060216 ◽

2019 ◽

Vol 55 (6) ◽

pp. 216

Author(s):

Stefano Miceli Sopo ◽

Mariannita Gelsomino ◽

Serena Rivetti ◽

Ester Del Vescovo

Keyword(s):

Diagnostic Criteria ◽

Food Challenge ◽

Oral Food Challenge ◽

Food Protein ◽

Consensus Guidelines ◽

Multiple Forms ◽

International Consensus ◽

Clinical Criteria ◽

Ige Mediated ◽

International Consensus Guidelines

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1–4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge.

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

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2014.12.1851 ◽

2015 ◽

Vol 135 (2) ◽

pp. AB279 ◽

Cited By ~ 1

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

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Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

Annals of Nutrition and Metabolism ◽

10.1159/000493671 ◽

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.

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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

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2016.12.966 ◽

2017 ◽

Vol 139 (4) ◽

pp. 1111-1126.e4 ◽

Cited By ~ 185

Author(s):

Anna Nowak-Węgrzyn ◽

Mirna Chehade ◽

Marion E. Groetch ◽

Jonathan M. Spergel ◽

Robert A. Wood ◽

...

Keyword(s):

American Academy ◽

Adverse Reactions ◽

Food Protein ◽

Consensus Guidelines ◽

International Consensus ◽

Executive Summary ◽

Diagnosis And Management ◽

International Consensus Guidelines

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Faculty Opinions recommendation of International consensus guidelines on anticardiolipin and anti-β2-glycoprotein I testing: report from the 13th International Congress on Antiphospholipid Antibodies.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13949987.15405098 ◽

2012 ◽

Author(s):

Maria Laura Bertolaccini

Keyword(s):

Antiphospholipid Antibodies ◽

International Congress ◽

Consensus Guidelines ◽

International Consensus ◽

Glycoprotein I ◽

International Consensus Guidelines

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Faculty Opinions recommendation of First international consensus guidelines for breast cancer in young women (BCY1).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718365319.793516581 ◽

2016 ◽

Author(s):

Gustavo Baldassarre

Keyword(s):

Breast Cancer ◽

Young Women ◽

Consensus Guidelines ◽

International Consensus ◽

International Consensus Guidelines

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SO-04 * INTERNATIONAL CONSENSUS GUIDELINES FOR POST-OPERATIVE STEREOTACTIC BODY RADIATION THERAPY (SBRT) FOR MALIGNANT SPINE TUMORS

Neuro-Oncology ◽

10.1093/neuonc/nou274.3 ◽

2014 ◽

Vol 16 (suppl 5) ◽

pp. v209-v209

Author(s):

K. Redmond ◽

S. Lo ◽

E. Chang ◽

P. Gerszten ◽

S. Chao ◽

...

Keyword(s):

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Consensus Guidelines ◽

International Consensus ◽

Stereotactic Body Radiation ◽

Spine Tumors ◽

International Consensus Guidelines

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Should Contrast-Enhanced Harmonic Endoscopic Ultrasound Be Incorporated into the International Consensus Guidelines to Determine the Appropriate Treatment of Intraductal Papillary Mucinous Neoplasm?

Journal of Clinical Medicine ◽

10.3390/jcm10091818 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1818

Author(s):

Tomohiro Yamazaki ◽

Mamoru Takenaka ◽

Shunsuke Omoto ◽

Tomoe Yoshikawa ◽

Rei Ishikawa ◽

...

Keyword(s):

Intraductal Papillary Mucinous Neoplasm ◽

Predictive Value ◽

Diagnostic Value ◽

Consensus Guidelines ◽

International Consensus ◽

Mucinous Neoplasm ◽

Appropriate Treatment ◽

Contrast Enhanced ◽

Diagnostic Values ◽

International Consensus Guidelines

This study aimed to investigate whether the incorporation of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) into the international consensus guidelines (ICG) for the management of intraductal papillary mucinous neoplasm (IPMN) could improve its malignancy diagnostic value. In this single-center retrospective study, 109 patients diagnosed with IPMN who underwent preoperative CH-EUS between March 2010 and December 2018 were enrolled. We analyzed each malignancy diagnostic value (sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV)) by replacing fundamental B-mode EUS with CH-EUS as the recommended test for patients with worrisome features (WF) (the CH-EUS incorporation ICG) and comparing the results to those obtained using the 2017 ICG. The malignancy diagnostic values as per the 2017 ICG were 78.9%, 42.3%, 60.0%, and 64.7% for Se, Sp, PPV, and NPV, respectively. The CH-EUS incorporation ICG plan improved the malignancy diagnostic values (Se 78.9%/Sp, 53.8%/PPV, 65.2%/NPV 70.0%). CH-EUS may be useful in determining the appropriate treatment strategies for IPMN.

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