Food allergy from an avoidance to a proactive approach

Wang, Julie; Fiocchi, Alessandro

doi:10.1097/aci.0b013e3283535a54

Cited by 1 publication

(1 citation statement)

References 20 publications

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“…Whereas in the case of IgE-mediated food allergies management is moving toward decreasing dietary restrictions, albeit with great caution (e.g. administration of baked milk or egg, oral immunotherapy), and although the current standard of care continues to entail strict avoidance of the food allergen for food allergy patients [8] , in the case of FPIES patients, avoidance of culprit foods is compulsory, and surrounded by little or no doubt. This certainty is due to at least three reasons: first, most FPIES patients achieve tolerance spontaneously before their fifth year of life, an important reason making oral immunotherapy less attractive; second, for the individual patient, it is difficult to know the minimal dose of culprit food that may cause an adverse reaction; it may even be infinitesimal.…”

Section: Long-term Dietary Management and Introduction Of At-risk Foomentioning

confidence: 99%

Clinical management of food protein-induced enterocolitis syndrome

Sopo

Iacono²,

Greco³

et al. 2014

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewThe article discusses the clinical management of patients affected by food protein-induced enterocolitis syndrome (FPIES), focusing on established therapeutic choices and future options.Recent findingsAfter FPIES has been diagnosed and avoidance of the culprit food prescribed, the most important management needs are as follows. First, recurrence of acute FPIES episodes due to accidental ingestion of culprit food. It may be useful to give patients’ families an action plan. The principal suggested treatments are intravenous fluids and steroids, whereas the use of epinephrine and ondansetron requires further study. In mild-to-moderate cases, oral rehydration should be sufficient. Second, dietary introduction of at-risk foods. In children with FPIES, in addition to that/those identified as culprit(s), some foods may not be tolerated (typically cow's milk, legumes, cereals, poultry). It has been suggested to avoid introducing these foods during the baby's first year. Otherwise, they may be given for the first time in hospital, performing an oral food challenge. Third, acquisition of tolerance. Children affected by cow's milk-FPIES have a good chance of acquiring tolerance by the time they reach age 18–24 months. For other culprit foods, insufficient data are available to indicate the appropriate time, so that it is suggested that an oral food challenge be performed about 1 year after the last acute episode.SummaryFuture clinical management of FPIES must take into account, among other factors, improved understanding of pathogenesis, possible detection of different phenotypes, and the introduction of more effective therapies for acute episodes. These factors will undoubtedly influence management decisions, which will become more diversified and effective.

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Section: Long-term Dietary Management and Introduction Of At-risk Foomentioning

confidence: 99%