Clinical features and resolution of food protein–induced enterocolitis syndrome: 10-year experience

Caubet, Jean-Christoph Roger J-P; Ford, Lara S.; Sickles, Laura; Järvinen, Kirsi M.; Sicherer, Scott H.; Sampson, Hugh A.; Nowak‐Węgrzyn, Anna

doi:10.1016/j.jaci.2014.04.008

Cited by 304 publications

(473 citation statements)

References 26 publications

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“…In contrast, in a large US case series, the median age of resolution was 6.7 years [18]. For soy-induced FPIES, the average reported age for tolerance is approximately 12 months, although this ranges from 6 months to >22 years [45].…”

Section: Fpies Caused By Cm/soymentioning

confidence: 83%

“…In a large US case series, the median age of resolution for CM-FPIES was 5.1 years, and in the UK, 25% of the patients had persistent CM-FPIES at 8 years of age [59]. In contrast, data from the same large US case series showed that the median ages of resolution were 4.7 years for rice and 4.0 years for oat [18]. Patients with positive skin prick test results to CM and or detectable serum CM-IgE (so called atypical CM-FPIES) are older at resolution (median, 13.8 years) than patients with a negative skin test [18].…”

Section: Fpies Caused By Cm/soymentioning

confidence: 94%

“…Reports of a series of infants with food protein-induced enterocolitis by Sicherer et al [11] (16 patients) and Burks et al [12] (43 patients) further characterized clinical features and refined food challenge protocols. More recent reports have identified various solid foods as triggers for FPIES [13][14][15][16][17][18]. Prior to implementation of the International Classification of Diseases, Tenth Revision (ICD-10) code for FPIES (K52.2) in October 2015, no uniform ICD code existed [19].…”

Section: Historical Perspectivementioning

confidence: 99%

“…Watery diarrhea (rarely with blood or mucus) develops in a subset of patients within 5-10 hours of ingestion and may last for up to 24 hours after exposure. Diarrhea is more common in infants and young children, and more commonly reported in Japan and Korea than in the US, UK, Australia, and Italy [15,18,21,[24][25][26]. Acute FPIES reactions usually resolve within 24 hours following ingestion, provided the offending food is eliminated from the diet.…”

Section: Acute Fpiesmentioning

confidence: 99%

“…Diagnosis of solid food FPIES tends to be later than for CM-FPIES [13,15,18,37,38]. Infants often present with a history of multiple reactions and have undergone extensive evaluations for alternative etiologies (infectious, toxic, metabolic) before diagnosis is confirmed [15,38].…”

Section: Fpies Caused By Solid Foodmentioning

confidence: 99%

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Food Protein–Induced Enterocolitis Syndrome

Nowak‐Węgrzyn

Jarocka-Cyrta

Castro

2017

J Investig Allergol Clin Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES. Key words: FPIES. Food protein-induced enterocolitis syndrome. Non-IgE-mediated food allergy. Food allergy. Cow milk allergy. ResumenSEIOA es una alergia alimentaria con patofisiología y prevalencia desconocidas, que típicamente comienza en el primer año de vida, mientras que la producida por pescado suelo tener su comienzo en adultos. La forma aguda se manifiesta entre la hora y 4 horas tras la ingesta del alimento con emesis, palidez, letargia progresiva por deshidratación y shock hipovolémico en el 15% de los casos. La forma crónica se manifiesta con emesis intermitente, diarreas y crecimiento pobre con progresión hacia la deshidratación y shock hipovolémico en un periodo de días o semanas. La forma crónica se ha podido observar únicamente en niños menores de 3 años alimentados con leche de vaca o fórmula de soja. Los desencadenantes más frecuentes son la leche de vaca, la soja, el arroz y avena. El diagnóstico es clínico y puede ser difícil debido a la ausencia de síntomas alérgicos típicos (urticaria, asma…) y a la relación retardada con la ingesta. Es recomendable la provocación controlada si el diagnóstico clínico o el alimento implicado no son claros y tamb...

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Section: Fpies Caused By Cm/soymentioning

confidence: 83%

Section: Fpies Caused By Cm/soymentioning

confidence: 94%

Section: Historical Perspectivementioning

confidence: 99%

Section: Acute Fpiesmentioning

confidence: 99%

Section: Fpies Caused By Solid Foodmentioning

confidence: 99%

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Food Protein–Induced Enterocolitis Syndrome

Nowak‐Węgrzyn

Jarocka-Cyrta

Castro

2017

J Investig Allergol Clin Immunol

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Recommendations on Complementary Food Introduction Among Pediatric Practitioners

et al. 2020

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IMPORTANCE The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear. OBJECTIVE To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods. DESIGN, SETTING, AND PARTICIPANTS In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger. MAIN OUTCOMES AND MEASURES The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items. RESULTS The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%).

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Food Allergy

Walker¹,

Gowland

2017

Analysis of Food Toxins and Toxicants

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Clinical features and resolution of food protein–induced enterocolitis syndrome: 10-year experience

Cited by 304 publications

References 26 publications

Food Protein–Induced Enterocolitis Syndrome

Food Protein–Induced Enterocolitis Syndrome

Recommendations on Complementary Food Introduction Among Pediatric Practitioners

Food Allergy

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