Acute‐on‐chronic food protein‐induced enterocolitis syndrome in an exclusively breast‐fed infant

Ntoumpara, Maria; Sotiriadou, Fotini; Fotoulaki, Maria

doi:10.1002/ccr3.1905

Cited by 9 publications

(8 citation statements)

References 9 publications

(14 reference statements)

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“…Monti et al (2011) described the first case of FPIES diagnosed in an infant caused by cow milk proteins passing through breast milk after accidental maternal ingestion 10 . Since then, only a few cases have been reported in breastfed children 11,12 . In this report, the patient was exclusively breastfed and no formulas were used, which raised concerns regarding the severe early onset of FPIES with acute symptoms.…”

Section: Discussionmentioning

confidence: 81%

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Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review

Almeida

Vásconez-Muñoz

Vásconez-Montalvo

et al. 2022

Clinical Case Reports

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Food protein-induced enterocolitis syndrome (FPIES) is a gastrointestinal, non-IgE mediated, and food hypersensitivity syndrome, and particularly occurs in infants during the introduction of new foods. There is no specific diagnostic test for FPIES, and therefore, diagnosis relies on medical records, symptoms presented, oral food challenges, and symptomatic relief after dietary avoidance. 1 Contrastingly, necrotizing enterocolitis (NEC) is a lifethreatening emergency of the gastrointestinal tract that almost exclusively affects newborns, with 70% of these cases occurring in preterm infants (<36 weeks of gestation). 2 This condition warrants treatment with broad-spectrum antibiotics, bowel rests, inotropes, and fluid support. 3 The diagnosis of FPIES can be challenging, as its clinical manifestations may mimic other diseases such as NEC, leading to misdiagnosis. Symptoms that arise in both conditions include vomiting, abdominal distention, diarrhea, bloody stools, feeding difficulties, lethargy, apnea, and shock. Additionally, in both conditions, diagnostic tests, such as abdominal radiography, may show intestinal dilatation, pneumatosis intestinalis (PI), and portal venous gas. 4 We present a case of FPIES in a 1-month-old, exclusively breastfed male, initially diagnosed with NEC, showing persistent PI on radiography and metabolic acidosis in the venous blood gas test. Our objective was to highlight the diagnostic difficulties associated with FPIES in exclusively breastfed infants. | CLINICAL CASEThe patient was a 1-month-old male, born at 38 + 6 weeks of gestation, with a history of transient tachypnea (requiring oxygen for less than 24 h) and a patent foramen ovale. He had no personal or family history of allergic conditions

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Section: Discussionmentioning

confidence: 81%

“…10 Since then, only a few cases have been reported in breastfed children. 11,12 In this report, the patient was exclusively breastfed and no formulas were used, which raised concerns regarding the severe early onset of FPIES with acute symptoms.…”

Section: Discussionmentioning

confidence: 98%

Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review

Almeida

Vásconez-Muñoz

Vásconez-Montalvo

et al. 2022

Clinical Case Reports

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“…Susp. AAF Miceli Sopo [ 18 ] Negative Not performed Yes No Miceli Sopo [ 18 ] Negative Not performed Yes No Monti [ 19 ] Negative Not performed Yes Yes Ntoumpara [ 20 ] Negative Non performed Yes a Yes Vergara Perez [ 21 ] Negative Non performed Yes No Kaya [ 22 ] Negative Positive Yes Yes Kaya [ 22 ] Negative Positive Yes Yes Tan [ 23 ] Negative Non performed Yes No T. F. Suspension Trigger Food Suspension, A. A. F. Amino Acid-based formula \ = No mention of a former diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…19,20 Rarely acute and chronic FPIES forms have been described in exclusively breastfed infants, caused by CM proteins. [21][22][23][24][25][26][27] Food protein-induced enterocolitis syndrome to soy or combined with CM in formula-fed infants is frequently described as a common trigger food in countries, such as the United States and Korea, in which soy formula is commonly used, whereas in other countries, such as Italy, Spain, Israel, UK and Australia, it is rare. 12,14,16,28,29 No cases of soy FPIES in exclusively breast-fed infants have been described so far.…”

Section: Non-solid Food (Cm/soy) Fpiesmentioning

confidence: 99%

“…Some exceptions to this are series from Australia 17 and the Southwest United States 18 where rice is the major culprit food, and Spanish series where fish is the main culprit 19,20 . Rarely acute and chronic FPIES forms have been described in exclusively breast‐fed infants, caused by CM proteins 21‐27 …”

Section: Introductionmentioning

confidence: 99%

'Diagnosing food protein‐induced enterocolitis syndrome'

Barni

Vazquez‐Ortiz

Giovannini

et al. 2020

Clin Experimental Allergy

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Food protein-induced enterocolitis syndrome is still a mysterious disease, pathogenically poorly characterized, although the first FPIES case has been described in 1967. Mainly, food protein-induced enterocolitis syndrome diagnosis is based on clinical history. The oral food challenge remains the gold standard to confirm the diagnosis, especially in particular situations. Although there are no diagnostic laboratory or imaging tests which are specific for diagnosis, they could, however, sometimes be helpful to rule out clinical conditions which are similar to food protein-induced enterocolitis syndrome reactions. The purpose of this review is to define the clinical features of FPIES and to summarize the current available tools for the diagnosis of FPIES. This review is intended to be a practical guide for the clinician facing a patient with food protein-induced enterocolitis syndrome avoiding delayed diagnosis with unnecessary laboratory tests and detrimental treatments. Moreover, it highlights the unmet needs in diagnosis that require urgent attention from the scientific community to improve the management of patients with FPIES.

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Acute‐on‐chronic food protein‐induced enterocolitis syndrome in an exclusively breast‐fed infant

Cited by 9 publications

References 9 publications

Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review

Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review

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

'Diagnosing food protein‐induced enterocolitis syndrome'

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