Non-IgE-mediated gastrointestinal food allergies

Bierme, P.; Nowak‐Węgrzyn, Anna; Caubet, Jean-Christoph Roger J-P

doi:10.1097/mop.0000000000000554

Cited by 12 publications

(21 citation statements)

References 90 publications

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Section: Discussionmentioning

confidence: 99%

“…Pediatric food allergies are common in the first two years of life and have an estimated prevalence between 3 and 8% [ 1 ]. FPIES, a non-IgE-mediated food allergy, had previously been considered a rare disorder, but due to raised awareness, recent studies have estimated its incidence at up to 0.3% of all newborns [ 1 , 3 ]. Food protein-induced allergic proctocolitis and food protein-induced enteropathy are also non-IgE-mediated food allergies, but they often have subacute to chronic presentations ranging from hemoccult-positive stools in healthy infants to chronic diarrhea causing failure to thrive [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Non-IgE-mediated food allergies can have acute or chronic presentations [ 1 ]. Food protein-induced enterocolitis syndrome (FPIES) is a rare, though severe, form of non-IgE-mediated food allergy that can present in infancy with predominant gastrointestinal signs and profound dehydration.…”

Section: Introductionmentioning

confidence: 99%

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Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock and Methemoglobinemia

Malin

Lutfi

Friedman

et al. 2018

Case Reports in Critical Care

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A 5-week-old previously healthy male presented with vomiting and diarrhea leading to hypovolemic shock and profound metabolic acidosis. He was subsequently found to have severe methemoglobinemia. The acidosis and shock improved with fluid resuscitation and methemoglobinemia was successfully treated with methylene blue. An extensive workup, including evaluations for infectious and metabolic etiologies, was unremarkable. However, a detailed dietary history revealed a recent change in diet, supporting a diagnosis of food protein-induced enterocolitis syndrome (FPIES). We present this case to highlight the importance of considering FPIES in an infant with vomiting and diarrhea, in the setting of a recent dietary change, leading to profound dehydration, metabolic acidosis, and methemoglobinemia. Diagnosis of FPIES, although difficult to make and one of exclusion, can be potentially life-saving.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock and Methemoglobinemia

Malin

Lutfi

Friedman

et al. 2018

Case Reports in Critical Care

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“…Non-IgE-mediated food allergies are typically resolved between 1 and 3 years of age, and the serotonin 5-HT3 receptor antagonist ondansetron has proven beneficial in some cases (155).…”

Section: Future Directionsmentioning

confidence: 99%

Mechanisms of gastrointestinal allergic disorders

Azouz¹,

Rothenberg²

2019

Journal of Clinical Investigation

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Gastrointestinal (GI) allergic disease is an umbrella term used to describe a variety of adverse, food antigen-driven, immunemediated diseases. Although these diseases vary mechanistically, common elements include a breakdown of immunologic tolerance, a biased type 2 immune response, and an impaired mucosal barrier. These pathways are influenced by diverse factors such as diet, infections, exposure to antibiotics and chemicals, GI microbiome composition, and genetic and epigenetic elements. Early childhood has emerged as a critical period when these factors have a dramatic impact on shaping the immune system and therefore triggering or protecting against the onset of GI allergic diseases. In this Review, we will discuss the latest findings on the molecular and cellular mechanisms that govern GI allergic diseases and how these findings have set the stage for emerging preventative and treatment strategies.

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“…There is no biological test for FPIES such as for non-IgE-mediated gastrointestinal food allergies [33]. The presence of cow’s milk-specific IgE has been described in one-third of patients with milk FPIES [34], a figure that seems higher in Japan [35].…”

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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Non-IgE-mediated gastrointestinal food allergies

Abstract: Despite major advances in the diagnosis and management of non-IgE-GI-FAs, particularly FPIES, the lack of specific diagnostic tests and biomarkers to guide clinical management remains challenging.

Cited by 12 publications

References 90 publications

Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock and Methemoglobinemia

Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock and Methemoglobinemia

Mechanisms of gastrointestinal allergic disorders

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

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