Long‐lasting non‐IgE‐mediated gastrointestinal cow's milk allergy in infants with Down syndrome

Wakiguchi, Hiroyuki; Hasegawa, Shunji; Kaneyasu, Hidenobu; Kajimoto, Madoka; Fujimoto, Yousuke; Hirano, Reiji; Katsura, Shunsaku; Matsumoto, Kenji; Ichiyama, Takashi; Ohga, Shouichi

doi:10.1111/pai.12351

Cited by 12 publications

(9 citation statements)

References 12 publications

(16 reference statements)

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“…Anecdotally, there seems to be an association between FPIES and Down syndrome. Wakiguchi et al reported prolonged CM‐FPIES in two children with Down syndrome. Immune dysregulation increased levels of TNF‐α and reduced levels of IL‐10 have been described in Down syndrome .…”

Section: Different Phenotypes Of Food Protein‐induced Enterocolitis Smentioning

confidence: 99%

Food protein‐induced enterocolitis syndrome

Caubet

Cianferoni

Groetch

et al. 2019

Clin Experimental Allergy

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Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE‐mediated gastrointestinal food allergic disorder that has gained a major interest the past decade. FPIES prevalence, which still needs to be accurately determine in different populations, appears to be higher than previously thought (ie up to 0.7% in infants in the 1st year of life). FPIES to seafood in adults is also increasingly reported; limited data suggest that adult FPIES is most commonly triggered by shellfish, tends to affect females more than men, is characterized by a significant delay in diagnosis and a prolonged course. The first international consensus guidelines on diagnosis and management of FPIES have been published in 2017, proposing new diagnostic criteria as well as new criteria for a positive oral food challenge. However, there is a need to develop new biomarkers to improve the diagnosis and management of FPIES patients, and this requires a better understanding of the pathophysiology. Recently, the role of T cells has been questioned and a major role of innate immune cells has been suggested in acute FPIES. Regarding the treatment of acute FPIES reaction, ondansetron has emerged as an adjunct to intravenous rehydration in moderate‐severe reactions and as a first‐line treatment in mild reactions. Important information regarding the nutritional management of FPIES patients that might be complex has also been provided in the international guidelines. In this review, we discuss recent advances regarding all those different aspects.

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Section: Different Phenotypes Of Food Protein‐induced Enterocolitis Smentioning

confidence: 99%

Food protein‐induced enterocolitis syndrome

Caubet

Cianferoni

Groetch

et al. 2019

Clin Experimental Allergy

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show abstract

“…We described the cases of three infants with Down syndrome who developed severe FPIES owing to milk-based formula. In children with Down syndrome, interleukin-10 levels are lower and tumor necrosis factor-α levels are higher than in those without it [ 3 ]. Wakiguchi et al [ 4 ] reported that FPIES in Down syndrome patients was worse due to immunological impairment, such as lower serum interleukin-10 levels.…”

Section: Discussionmentioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock in Infants With Down Syndrome

Iguchi

Aoki²,

Kitazawa

2021

Cureus

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This study aimed to investigate the clinical characteristics of severe food protein-induced enterocolitis syndrome (FPIES) in patients with Down syndrome. We report the cases of three infants with Down syndrome who were diagnosed with FPIES. All patients presented with hypovolemic shock, metabolic acidosis, and acute kidney injury after introducing a milk-based formula. They required aggressive fluid resuscitation and alternative nutrition. All three patients survived without any complications after the treatment. FPIES may cause hypovolemic shock in infants with Down syndrome and these patients need prompt fluid resuscitation.

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“…Interestingly, both FPIES and FPE have been reported in patients with Down syndrome, who may present with a protracted course [15,28,29]. This may be due to intrinsic immune defects seen in these children [30], which include the dysregulated secretion of TNFα and IL-10 [31,32], two key cytokines implicated in FPIES, as described below.…”

Section: Epidemiologymentioning

confidence: 97%

Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update

2020

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Non-immunoglobulin E-mediated gastrointestinal food allergic disorders (non-IgE-GI-FA) include food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE) and food protein-induced allergic proctocolitis (FPIAP), which present with symptoms of variable severity, affecting the gastrointestinal tract in response to specific dietary antigens. The diagnosis of non-IgE-GI-FA is made clinically, and relies on a constellation of typical symptoms that improve upon removal of the culprit food. When possible, food reintroduction should be attempted, with the documentation of symptoms relapse to establish a conclusive diagnosis. Management includes dietary avoidance, nutritional counselling, and supportive measures in the case of accidental exposure. The prognosis is generally favorable, with the majority of cases resolved before school age. Serial follow-up to establish whether the acquisition of tolerance has occurred is therefore essential in order to avoid unnecessary food restriction and potential consequent nutritional deficiencies. The purpose of this review is to delineate the distinctive clinical features of non-IgE-mediated food allergies presenting with gastrointestinal symptomatology, to summarize our current understanding of the pathogenesis driving these diseases, to discuss recent findings, and to address currents gaps in the knowledge, to guide future management opportunities.

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Long‐lasting non‐IgE‐mediated gastrointestinal cow's milk allergy in infants with Down syndrome

Cited by 12 publications

References 12 publications

Food protein‐induced enterocolitis syndrome

Food protein‐induced enterocolitis syndrome

Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock in Infants With Down Syndrome

Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update

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