Chronic Milk-Dependent Food Protein-Induced Enterocolitis Syndrome in Children from West Pomerania Region

Characteristics of chronic milk-dependent food protein-induced enterocolitis syndrome (FPIES) in children from the region of Western Pomerania were studied. Prospectively, 55 children were diagnosed at a median of 2.2 months. The open food challenges (OFC), morphologies, milk-specific IgE (sIgE) (FEIA method, CAP system), and skin prick tests (SPTs) were examined. Vomiting and diarrhea escalated gradually but quickly led to growth retardation. Of the infants, 49% had BMI < 10 c, 20% BMI < 3 c; 25% had anemia, and 15% had hypoalbuminemia. During the OFCs we observed acute symptoms that appeared after 2–3 h: vomiting diarrhea and pallor. A total of 42% children required intravenous hydration. Casein hydrolysates or amino acids formulae (20%) were used in treatment. In 25% of children, SPT and milk sIgE were found, in 18%—other food SPTs, and in 14% allergy to other foods. A transition to IgE-dependent milk allergy was seen in 3 children. In the twelfth month of life, 62% of children had tolerance to milk, and in the twenty-fifth month—87%. Conclusions. Chronic milk-dependent FPIES resolves in most children. By the age of 2 children are at risk of multiple food sensitization, and those who have milk sIgE are at risk to transition to IgE-mediated milk allergy. Every OFC needs to be supervised due to possible severe reactions.

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

Pediatric Allergy and Immunology ◽

10.1111/pai.12878 ◽

2018 ◽

Vol 29 (4) ◽

pp. 446-447 ◽

Cited By ~ 8

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

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Multiple Food Protein Intolerance of Infancy or Severe Spectrum of Non-IgE-Mediated Cow's Milk Allergy? - a Case Series

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2014.12.1891 ◽

2015 ◽

Vol 135 (2) ◽

pp. AB387

Author(s):

Vicki L. McWilliam ◽

Mimi L.K. Tang ◽

Ralf G. Heine ◽

Katrina Jane Allen

Keyword(s):

Case Series ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Food Protein ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Ige Mediated ◽

Protein Intolerance

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Decreased Histone Acetylation Levels at Th1 and Regulatory Loci after Induction of Food Allergy

Nutrients ◽

10.3390/nu12103193 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3193

Author(s):

Bilal Alashkar Alhamwe ◽

Laura A. P. M. Meulenbroek ◽

Désirée H. Veening-Griffioen ◽

Tjalling M. D. Wehkamp ◽

Fahd Alhamdan ◽

...

Keyword(s):

Gene Expression ◽

Food Allergy ◽

Histone Acetylation ◽

Specific Ige ◽

Allergic Response ◽

Cow’S Milk ◽

Milk Allergy ◽

T Helper ◽

Cow's Milk ◽

Ige Mediated

Immunoglobulin E (IgE)-mediated allergy against cow’s milk protein fractions such as whey is one of the most common food-related allergic disorders of early childhood. Histone acetylation is an important epigenetic mechanism, shown to be involved in the pathogenesis of allergies. However, its role in food allergy remains unknown. IgE-mediated cow’s milk allergy was successfully induced in a mouse model, as demonstrated by acute allergic symptoms, whey-specific IgE in serum, and the activation of mast cells upon a challenge with whey protein. The elicited allergic response coincided with reduced percentages of regulatory T (Treg) and T helper 17 (Th17) cells, matching decreased levels of H3 and/or H4 histone acetylation at pivotal Treg and Th17 loci, an epigenetic status favoring lower gene expression. In addition, histone acetylation levels at the crucial T helper 1 (Th1) loci were decreased, most probably preceding the expected reduction in Th1 cells after inducing an allergic response. No changes were observed for T helper 2 cells. However, increased histone acetylation levels, promoting gene expression, were observed at the signal transducer and activator of transcription 6 (Stat6) gene, a proallergic B cell locus, which was in line with the presence of whey-specific IgE. In conclusion, the observed histone acetylation changes are pathobiologically in line with the successful induction of cow’s milk allergy, to which they might have also contributed mechanistically.

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Non-IgE Mediated Food Allergy

Current Pediatric Reviews ◽

10.2174/157339631566619103110371 ◽

2020 ◽

Vol 16 (2) ◽

pp. 95-105

Author(s):

Antonella Cianferoni

Keyword(s):

Food Allergy ◽

Eosinophilic Esophagitis ◽

Allergic Diseases ◽

Food Allergies ◽

Food Protein ◽

Ige Mediated ◽

Food Challenges ◽

Allergic Proctocolitis ◽

Eosinophilic Disorders

Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. Non-IgE mediated food allergies are being being investigated.

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Multiple food protein intolerance of infancy or severe spectrum of non—IgE-mediated cow's milk allergy?—A case series

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2015.12.001 ◽

2016 ◽

Vol 4 (2) ◽

pp. 324-326 ◽

Cited By ~ 1

Author(s):

Vicki McWilliam ◽

Ralf Heine ◽

Mimi L.K. Tang ◽

Katrina J. Allen

Keyword(s):

Case Series ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Food Protein ◽

Milk Allergy ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Ige Mediated ◽

Protein Intolerance

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Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

Allergologia et Immunopathologia ◽

10.15586/aei.v49i3.103 ◽

2021 ◽

Vol 49 (3) ◽

pp. 120-130

Author(s):

Guilia Ballini ◽

Chiara Gavagni ◽

Caterina Guidotti ◽

Giulia Ciolini ◽

Giulia Liccioli ◽

...

Keyword(s):

Chart Review ◽

Tertiary Care ◽

Food Challenge ◽

Retrospective Chart Review ◽

Food Protein ◽

Pediatric Hospital ◽

Pediatric Allergy ◽

Trained Personnel ◽

Ige Mediated ◽

Food Challenges

Introduction and objective: The oral food challenge (OFC) is the gold standard to diagnose food allergy (FA); however, it is not a procedure free from the risk of having significant allergic reactions, even life-threatening.The aims of our study were to evaluate the frequency of positive OFCs performed in chil-dren with a suspected diagnosis of IgE- and non-IgE–mediated (food protein–induced enterocolitis syndrome (FPIES)) FA and how the failed challenges were managed.Materials and methods: A retrospective chart review was done on all children who have had OFCs in a tertiary-care pediatric allergy unit from 2017 to 2019.Results: 682 patients were enrolled and 2206 challenges were performed: 2058 (93%) for IgE-mediated FA and 148 (7%) for FPIES. There were 262 (11.8%) challenge failures. The transfer to the emergency department was required 3 times (1.1%). None of the failed challenges resulted in death or hospitalization and 13.3% challenges did not require any treatment.Conclusions: Our findings confirm that food challenges can be performed safely in a specialized setting by well-trained personnel; all food challenge reactions, even the most serious, were reversible, thanks to a prompt recognition and treatment that generally did not worsen over time.

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Establishing a Milk Specific IgE Decision Point in IgE Mediated Cow'S Milk Allergy (CMA) Patients from a Tertiary Pediatric Brazilian Center

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2005.12.182 ◽

2006 ◽

Vol 117 (2) ◽

pp. S44 ◽

Cited By ~ 2

Author(s):

A.K.F. Gushken ◽

A.P.M. Castro ◽

A.C. Pastorino ◽

E. Ciccone ◽

R.F.F. Gonçalves ◽

...

Keyword(s):

Specific Ige ◽

Cow’S Milk Allergy ◽

Cow’S Milk ◽

Milk Allergy ◽

Decision Point ◽

Cow's Milk ◽

Cow's Milk Allergy ◽

Ige Mediated

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Non-IgE Mediated Food Allergy

Current Pediatric Reviews ◽

10.2174/1573396315666191031103714 ◽

2020 ◽

Vol 16 (2) ◽

pp. 95-105

Author(s):

Antonella Cianferoni

Keyword(s):

Food Allergy ◽

Eosinophilic Esophagitis ◽

Allergic Diseases ◽

Food Allergies ◽

Food Protein ◽

Ige Mediated ◽

Food Challenges ◽

Allergic Proctocolitis ◽

Eosinophilic Disorders

: Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. : Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. : In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. : Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. : The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. : Non-IgE mediated food allergies are being being investigated.

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