Food protein–induced enterocolitis syndrome: Not so rare after all!

Nowak‐Węgrzyn, Anna; Spergel, Jonathan M.

doi:10.1016/j.jaci.2017.07.020

Cited by 12 publications

(3 citation statements)

References 10 publications

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“…Mehr et al recently published a population-based study in Australia, in which they accounted for new diagnoses of FPIES from 2012 to 2014 in infants younger than 24 months of age [13]. The incidence of FPIES was 15.4/100,000 cases per year, signaling that FPIES is not as rare as once believed [14]. Alternatively, the perceived increase in FPIES cases might be related to the increased awareness of the disorder.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome: a Comprehensive Review

Agyemang¹,

Nowak‐Węgrzyn²

2019

Clinic Rev Allerg Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that has been well-characterized clinically, yet it is still poorly understood. Acute FPIES is characterized by vomiting 1-4 h and/or diarrhea within 24 h after ingestion of a culprit food. Chronic FPIES is the result of chronic exposure to an offending food that can result in chronic watery diarrhea, intermittent vomiting, and failure to thrive. FPIES typically presents in infancy and self-resolves by school age in most patients. Adult-onset FPIES is rare, but it has been reported. Cow's milk and soy are the most common triggering foods in infants in the US, and as solids are introduced in the diet, FPIES reactions to grains (rice, oat) increase in prevalence. Variability in common trigger foods exists depending on the geographical origin-for example, fish is a frequent trigger in Spanish and Italian patients. Heavy reliance on a detailed history is required for the diagnosis as physical exam findings, laboratory tests, and/or imaging studies are suggestive and not specific for FPIES. Oral food challenges remain the gold standard for confirming diagnosis, and the challenge protocol may be for an individual depending on risk of reaction, prior reaction severity, and positive-specific IgE status. The recent development of diagnostic criteria in 2017 will serve to increase recognition of the disorder and allow for early implementation of management strategies. Acute management during reactions includes IV hydration, anti-emetics, and IV corticosteroids. Reaction prevention strategies include strict food avoidance until the physician deems a food reintroduction challenge clinically appropriate. Future efforts in FPIES research should be aimed at elucidating the underlying disease mechanisms and possible treatment targets. Keywords FPIES . Food protein-induced enterocolitis syndrome . Food allergy . Cow's milk . Soy . Oral food challenge Abbreviations CM cow's milk FPIES food protein-induced enterocolitis syndrome sIgE specific IgE OFC oral food challenge

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Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome: a Comprehensive Review

Agyemang¹,

Nowak‐Węgrzyn²

2019

Clinic Rev Allerg Immunol

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“…Very frequently, FPIES is not recognized at the first visit, whether in its chronic or acute form; owing to both the lack of associated typical cutaneous and respiratory allergic symptoms [28] and the lack of knowledge of this “emerging” syndrome among physicians [29-32]. This lack of knowledge includes the common belief that rice, oat, and vegetables are hypoallergenic and can never induce an allergic reaction.…”

Section: Food Protein-induced Enterocolitis Syndromementioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

Dupont¹

2018

Ann Nutr Metab

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Non-IgE-mediated, also labeled cell-mediated, allergic reactions to foods are more common than usually thought and probably account for approximately more than 40% of cases of cow’s milk allergy during infancy and young childhood. Food allergy is now described in the form of syndromes, among which food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP) are gaining increased recognition. FPIES occurs in infancy but may also occur in older children and in adults. The dominant symptom is emesis, repetitive in the chronic FPIES form and explosive in the acute form. Acute FPIES begins 1– 4 h following ingestion of the offending food. Diarrhea is frequent, between 5 and 10 h later, and may be accompanied by lethargy and dehydration, which both characterize severity. Cow’s milk is the most frequent food trigger, followed by soy. FPIES may develop up to 1 year of age, but may also occur in the newborn, and is possible in exclusively breastfed infants, in relation with the mother’s consumption of offending foods. FPIES may occur to solid foods (grains like rice or oat, meats, fish, egg, and vegetables). When starting during infancy, FPIES has a good prognosis and disappears grossly at 2 years of age. FPIES to fish or shellfish is more frequent in older children and adults and is long lasting. International consensus guidelines for the diagnosis and management of FPIES have been published recently. FPIAP starts in the first few months of life and is typically manifested with rectal bleeding in well-appearing breastfed infants during the first months of life in reaction to cow’s milk consumed by the mother. The condition is transient but represents one of the major causes of colitis during infancy.

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“…The average age of diagnosis was seven months. Although the majority of the patients experience resolution of FPIES usually by three to five years of age, a subset has persistent FPIES into adolescence and adulthood [8].…”

Section: Epidemiologymentioning

confidence: 99%

Food protein-induced enterocolitis syndrome – a little-known form of non-IgE-mediated food hypersensitivity

Skiba¹,

Boznański²

2018

polp

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Food protein-induced enterocolitis syndrome (FPIES) is a presentation of non-IgE-mediated food allergy and is probably more common than is currently diagnosed. Epidemiological data that estimate the prevalence of this disease are limited. In infancy it is usually induced by cow's milk protein, rice, and soybean; in older children and adults fish and seashell may be the triggering factors. It is characterised by the presence of vomiting and diarrhoea that can lead to dehydration, lethargy, pallor, and metabolic acidosis. Chronic FPIES usually presents as failure to thrive. The diagnosis is based on clinical criteria. Potential cases can be misdiagnosed as more common paediatric illnesses, such as gastroenteritis or sepsis. Treatment consists of education and avoidance of the offending foods. In 2017 international guidelines for the diagnosis and management of FPIES were published [1]. This article contains current information on food protein-induced enterocolitis syndrome.

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Food protein–induced enterocolitis syndrome: Not so rare after all!

Cited by 12 publications

References 10 publications

Food Protein-Induced Enterocolitis Syndrome: a Comprehensive Review

Food Protein-Induced Enterocolitis Syndrome: a Comprehensive Review

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

Food protein-induced enterocolitis syndrome – a little-known form of non-IgE-mediated food hypersensitivity

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