Comparison of methemoglobin levels in food protein-induced enterocolitis syndrome and other gastrointestinal diseases in neonates

Makita, Eishi; Kuroda, Sae; Sato, Hiroaki; Itabashi, Kae; Kawano, Atsuko; Matsuura, Misa; Sugiyama, Yohei; Sugawara, Daisuke; Maruyama, Asami; Ichihashi, Ko

doi:10.1016/j.aller.2020.01.007

Cited by 11 publications

(6 citation statements)

References 17 publications

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“…This increased amount of NO results in excessive oxidation of hemoglobin, which increases MHb levels. 2 The second mechanism suggests that decreased activity of the enzyme responsible for nitrite and nitrate metabolism leads to methemoglobinemia. Under normal physiologic conditions, nitrites and nitrates are metabolized and excreted through the GI and renal systems.…”

Section: Discussionmentioning

confidence: 99%

Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations

Rigg

Kesavan²,

Patel

2023

Clin Pediatr (Phila)

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Section: Discussionmentioning

confidence: 99%

Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations

Rigg

Kesavan²,

Patel

2023

Clin Pediatr (Phila)

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“…There are also other food‐associated conditions that can lead to methemoglobinemia indirectly, in which there is no oxidant in the food itself, placing them outside the scope of our study. Case series of FPIES have described methemoglobin fractions of up to 10.9%, which required no specific treatment (Geljic & Hojsak, 2020; Makita et al., 2020). A model for the underlying pathophysiology in FPIES implicates inflammation in disrupting normal enzymatic processes.…”

Section: Discussionmentioning

confidence: 99%

Food‐induced methemoglobinemia: A systematic review

McNulty

Kuchi

et al. 2022

Journal of Food Science

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Methemoglobinemia is a sporadic, potentially fatal disease of poor tissue oxygenation in which ferrous hemoglobin (Fe2+) is oxidized to the ferric (Fe3+) state, rendering it incapable of binding oxygen (O2). Fortunately, it is diagnosable and treatable. Here, we present a systematic review of food‐induced methemoglobinemia. PubMed and Embase databases were searched using the term “methemoglobin*,” for articles up to December 31, 2020. Inclusion criteria were confirmed or probable cases of methemoglobinemia with an oxidant confirmed in food or body tissue samples, or the oxidant likely to have come from food. We found 97 articles describing 568 cases. Median age was 6 years (range: 2 weeks to 80 years). Median methemoglobin fraction was 30% (n = 142). Oxidizing agents were predominantly nitrites and nitrates. The commonest type of presentation was children eating vegetables (30%), followed by accidental ingestions (27%), and meat curing misadventures (22%). Favism was found to result in mild methemoglobinemia, highest fraction reported was 15.8%. Of the 35 deaths, 32 were from accidental ingestions (91%). In some fatal cases, diagnosis was likely delayed or missed, and antidote was not administered. The majority of cases survived, even with severe methemoglobin levels of up to 89%, provided that methylene blue was administered. Treatment with methylene blue alone resulted in an average methemoglobin drop of 39.1% (n = 22). Methemoglobinemia cases continue to occur due to accidental exposure, meat curing misadventures, and babies ingesting nitrate‐rich vegetables which have been inappropriately stored. Early recognition of the toxidrome, instituting antidote treatment, and notifying public health authorities are key to improved outcomes.

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“…An adequate anamnesis, clinical presentation, and laboratory findings were key to suspect this diagnosis. Clinically, this is not the most common manifestation, although severe methemoglobinemia with acute intestinal inflammation has been previously described in FPIES [ 5 - 7 ]. There is no exact cause of methemoglobinemia in FPIES, but the result is severe intestinal inflammation and decreased catalase activity, resulting in increased intestinal nitrites and increased heme molecule oxidation, which contributes to methemoglobinemia [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

A Cyanotic Infant: Infrequent Presentation of Cow’s Milk Protein Allergy

Sánchez¹,

Simarro²,

Martín³

et al. 2022

Cureus

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We report the case of a three-month-old boy who presented with poor weight gain, loose stools, and poor oral intake for three weeks. Physical examination revealed a pale infant with abdominal distension and cyanosis. Oxygen saturation was normal, but the laboratory showed important methemoglobinemia. The diagnosis of FPIES (food protein-induced enterocolitis syndrome) in the context of cow's milk protein allergy (CMPA) was suspected. Although CMPA is a common condition encountered in small children, chronic forms of FPIES can be difficult to diagnose. Maintaining clinical suspicion about the potential association between methemoglobinemia and gastrointestinal symptoms can lead to prompt recognition and intervention.

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Comparison of methemoglobin levels in food protein-induced enterocolitis syndrome and other gastrointestinal diseases in neonates

Cited by 11 publications

References 17 publications

Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations

Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations

Food‐induced methemoglobinemia: A systematic review

A Cyanotic Infant: Infrequent Presentation of Cow’s Milk Protein Allergy

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