Management of acute food protein-induced enterocolitis syndrome emergencies at home and in a medical facility

Leonard, Stephanie A.; Sopo, Stefano Miceli; Baker, Mary Grace; Fiocchi, Alessandro; Wood, Robert A.; Nowak‐Węgrzyn, Anna

doi:10.1016/j.anai.2021.01.020

Cited by 10 publications

(6 citation statements)

References 42 publications

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“…Vomiting is defined as an expulsion with force of the refluxed gastric contents from the mouth [25] and is a coordinated autonomic and voluntary motor response, causing forceful expulsion of gastric contents [25]. In food-protein induced enterocolitis syndrome (FPIES), there is chronic vomiting in the chronic presentation and forceful vomiting in acute FPIES [26]. In both cases, vomiting is related to a CNS emetic reflex triggered by the presence of milk in the digestive tract.…”

Section: Regurgitationmentioning

confidence: 99%

The Cow’s Milk Related Symptom Score: The 2022 Update

et al. 2022

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CoMiSS® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow’s milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we aim to propose an updated CoMiSS. The evidence was reviewed, debated and discussed by 10 experts, of whom seven were part of the original group. The panel concluded that the cut-off previously proposed to indicate the likelihood that symptoms may be cow’s milk related should be lowered from ≥12 to ≥10. Data in healthy infants > 6 months are missing. Since the Brussels Infant and Toddlers Stool Scale (BITSS) was recently developed for non-toilet trained children, the Bristol Stool Scale was changed to the BITSS without changing the impact of stool characteristics on CoMiSS. Overall, CoMiSS raises awareness that symptoms might be cow’s milk related. New studies are needed to determine if the change in cut-off and other small adaptions improve its sensitivity and specificity. Data for CoMiSS is still needed in presumed healthy infants between 6 and 12 months old. There may also be regional differences in CoMiSS, in healthy infants as well as in those with cow’s milk allergy. Finally, we emphasize that CoMiSS is an awareness tool and not a diagnostic test.

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Section: Regurgitationmentioning

confidence: 99%

The Cow’s Milk Related Symptom Score: The 2022 Update

et al. 2022

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Section: Introductionmentioning

confidence: 99%

“…Management of FPIES varies on a case-by-case basis; however, avoidance of the food trigger is generally recommended [10]. Acute FPIES reactions can be expected to resolve themselves in 4-12 h after onset, while chronic FPIES reactions resolve after 3-10 days of avoiding the trigger food [10]. Mild reactions typically resolve with oral rehydration, while moderate to severe reactions can require aggressive fluid resuscitations with repeated saline boluses [10].…”

Section: Introductionmentioning

confidence: 99%

“…Acute FPIES reactions can be expected to resolve themselves in 4-12 h after onset, while chronic FPIES reactions resolve after 3-10 days of avoiding the trigger food [10]. Mild reactions typically resolve with oral rehydration, while moderate to severe reactions can require aggressive fluid resuscitations with repeated saline boluses [10]. Corticosteroids have also been recommended for patients with severe symptoms because of the presumed cell-mediated inflammation [10].…”

Section: Introductionmentioning

confidence: 99%

“…Mild reactions typically resolve with oral rehydration, while moderate to severe reactions can require aggressive fluid resuscitations with repeated saline boluses [10]. Corticosteroids have also been recommended for patients with severe symptoms because of the presumed cell-mediated inflammation [10]. Epinephrine is not recommended for FPIES reactions as it is not an IgE-mediated condition [10].…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review of Food Protein-Induced Enterocolitis Syndrome

Prattico¹,

Mulé²,

Ben‐Shoshan³

2023

Int Arch Allergy Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food-induced hypersensitivity disorder that occurs mostly in infants. Long considered a rare disease, a recent increase in physician awareness and publication of diagnosis of guidelines has resulted in an increase in recognized FPIES cases. We aimed to conduct a systematic review of FPIES studies in the past 10 years. A search was conducted on PubMed and Embase in March 2022. Our systematic review focused on 2 domains: (1) the most reported FPIES food triggers; and (2) the resolution rate and median age at resolution of patients with FPIES. We found that cow’s milk was the most reported trigger globally. Patterns of the most common triggers varied by country, with fish being one of the most common triggers in the Mediterranean region. We also found that the rate and median age of resolution varied by trigger. Patients with FPIES to cow’s milk acquired tolerance at a younger age (most by age 3 years), while fish-FPIES was more persistent (mean resolution by age 37 months–7 years). Overall, many studies found a resolution rate of 60% for any food.

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