Phenotypes and natural history of food protein‐induced enterocolitis syndrome in the east Mediterranean region

2020 ◽  
Vol 41 (6) ◽  
pp. 420-427 ◽  
Author(s):  
Melike Ocak ◽  
Ayşegül Akarsu ◽  
Umit Murat Sahiner ◽  
Ozge Soyer ◽  
Bulent Enis Sekerel
Keyword(s):  
Clinical Symptoms ◽  
Emergency Department Visits ◽  
Interquartile Range ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk ◽  
Hen’S Egg ◽  
History Of ◽  
Ige Mediated ◽  
East Mediterranean Region

Background: Food protein‐induced enterocolitis syndrome (FPIES) is a rare non-IgE mediated food allergy. Objective: To delineate the differences in the spectrum of culprit foods, remission patterns, and predictors among varying cultures. Methods: We reviewed demographics, culprit foods, outcomes, and predictors in 81 children with a diagnosis of FPIES who were followed up between 2015 and 2020. Results: Eighty-one patients (55.6% boys) were enrolled, including 72 with acute FPIES and 9 with chronic FPIES. Hen’s egg was the most common culprit food (36.6%), followed by fish (26.9%), and cow’s milk (21.5%). Interestingly, cow’s milk was significantly prevalent in chronic FPIES cases (p = 0.006). The most common clinical symptoms were vomiting (100%), pallor (63.4%), and lethargy (55.9%). Emergency department visits were noted in 39 patients (41.9%), of whom 37 (39.8%) were treated with intravenous (IV) fluid. The subjects were followed up for a median (interquartile range) of 19.4 months (12.3‐41.2 months), and 26 subjects (32.1%) achieved tolerance. The median (interquartile range) age at tolerance was 2.5 years (2.1‐3.2 years). With regard to the culprit foods, hen’s egg was observed more frequently in the subjects with resolved FPIES cases (p = 0.008), whereas fish FPIES cases were high in the persistent group (p = 0.001). IgE sensitization of the culprit food was found to be an independent risk factor for the persistence of FPIES (odds ratio 4.855 [95% confidence interval, 1.131‐20.844]; p = 0.034). Conclusion: In our cohort, unlike other published series, hen’s egg and fish were the two most common culprit foods. Fish differed from other culprit foods, with significantly delayed onset and persistence, and may create a model that allows for the understanding of the disease.

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

The natural history of IgE-mediated cow's milk allergy

2007 ◽  
Vol 120 (5) ◽  
pp. 1172-1177 ◽  
Author(s):  
Justin M. Skripak ◽  
Elizabeth C. Matsui ◽  
Kim Mudd ◽  
Robert A. Wood
Keyword(s):  
Natural History ◽  
Cow’S Milk Allergy ◽  
Cow’S Milk ◽  
Milk Allergy ◽  
Cow's Milk ◽  
Cow's Milk Allergy ◽  
History Of ◽  
Ige Mediated

The Natural History of IgE-Mediated Cow's Milk Allergy

PEDIATRICS ◽  
2008 ◽  
Vol 122 (Supplement 4) ◽  
pp. S186.1-S186
Author(s):  
Scott H. Sicherer
Keyword(s):  
Natural History ◽  
Cow’S Milk Allergy ◽  
Cow’S Milk ◽  
Milk Allergy ◽  
Cow's Milk ◽  
Cow's Milk Allergy ◽  
History Of ◽  
Ige Mediated

scholarly journals Food-induced anaphylaxis in early childhood and factors associated with its severity

2021 ◽  
Vol 42 (5) ◽  
pp. e135-e144 ◽  
Author(s):  
Metin Aydogan ◽  
Erdem Topal ◽  
Nalan Yakıcı ◽  
Hazal Cansu Acar ◽  
Zeynep Hızlı Demirkale ◽  
...  
Keyword(s):  
Early Childhood ◽  
Cow’S Milk ◽  
Cow's Milk ◽  
Factors Associated ◽  
Pediatric Allergy ◽  
Severe Anaphylaxis ◽  
Medical Chart Review ◽  
Allergy And Immunology ◽  
Hen’S Egg ◽  
History Of

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6‐18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.

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.

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.

Atopy patch test in children with cow's milk and hen's egg allergy: Do clinical symptoms matter?

2020 ◽  
Vol 48 (4) ◽  
pp. 323-331
Author(s):  
S. Sirin Kose ◽  
S. Asilsoy ◽  
D. Tezcan ◽  
G. Atakul ◽  
S. Al ◽  
...  
Keyword(s):  
Patch Test ◽  
Clinical Symptoms ◽  
Cow’S Milk ◽  
Atopy Patch Test ◽  
Egg Allergy ◽  
Cow's Milk ◽  
Hen’S Egg

scholarly journals Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

2021 ◽  
Vol 2 ◽  
Author(s):  
Mikaela Sekkidou ◽  
Leilani Muhardi ◽  
Constantina Constantinou ◽  
Urszula Kudla ◽  
Yvan Vandenplas ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Case Series ◽  
Cow’S Milk ◽  
Nutritional Management ◽  
Term Infants ◽  
Specific Product ◽  
Cow's Milk ◽  
Case Series Report ◽  
Ige Mediated

Background: The majority of mixed-fed infants with non-IgE-mediated cow's milk protein allergy (CMPA) enteropathies are managed with an extensively hydrolysed cow's milk based infant formula (eHF). Given the high variability in peptide distribution of available eHFs, it is important to understand the suitability of a specific product in the management of distinct phenotypes.Objective: To assess the symptom resolution of various phenotypes of clinical manifestations of CMPA enteropathies and constipation managed by a casein-based eHF.Methods: The data of 20 full-term infants (n = 15 with non-IgE-mediated CMPA and n = 5 with constipation) attending a paediatric allergy clinic in Cyprus and managed with a casein-based eHF were retrospectively analysed.Results: Based on the clinical symptoms and history, infants were classified into the following phenotypes: (a) 11/15 (73.3%) FPIAP, (b) 3/15 (20%) FPIES, and (c) 1/15 (6.7%) severe diarrhoea. Overall, 14 (93.3%) patients were successfully managed with the casein-based eHF and 1 (6.7%) required an AAF. This formula was effective in 91% of patients with FPIAP, in 100% with FPIES and with diarrhoea. Three (60%) patients with constipation responded to the eHF.Conclusion: This case-series report supports the efficacy of a particular casein-based eHF for the nutritional management of non-IgE mediated CMPA enteropathies.

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