The threshold for immune cell reactivity to milk antigens decreases in cow’s milk allergy with intestinal symptoms

Benlounes, Nadia; Dupont, Christophe; Candalh, Céline; Blaton, Marie-Agnès; Darmon, Nicole; Desjeux, Jehan-François; Heyman, Martine

doi:10.1016/s0091-6749(96)70127-6

Cited by 55 publications

(30 citation statements)

References 21 publications

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“…In some FPIES cases, patients have been reported to have detectable IgE levels to the causative protein, either at presentation or during follow-up,2 even though typically in FPIES patients are negative for food specific IgE antibodies. The presence of food specific IgE has been suggested to be a poor prognostic sign for outgrowing cow’s milk allergy 13. In the present study, food specific IgE antibodies to cow’s milk and soy were evaluated using the Uni-CAP system at initial diagnosis, but all findings were negative.…”

Section: Discussionmentioning

confidence: 80%

Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome

Hwang

Sohn

Kim

2008

Archives of Disease in Childhood

139

104

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Section: Discussionmentioning

confidence: 80%

Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome

Hwang

Sohn

Kim

2008

Archives of Disease in Childhood

139

104

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“…Fecal TNF-a was also found in increased concentrations after positive milk challenge in patients with CM-induced gastrointestinal reactions. 26,27 Benlounes et al 28 showed that significantly lower doses of intact CM protein stimulated TNF-a secretion from PBMCs of patients with active intestinal CM allergy compared either with patients whose sensitivity resolved or with those with skin, rather than intestinal, manifestations of CM hypersensitivity. In addition, in vitro kinetic studies differed in these groups, with those having active disease showing 2 peaks in TNF-a elaboration.…”

Section: Pathophysiologymentioning

confidence: 99%

Food protein-induced enterocolitis syndrome: Case presentations and management lessons

Sicherer

2005

Journal of Allergy and Clinical Immunology

216

198

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“…Higher baseline tryptase levels (although within normal range for age) were found in children with active CM-FPIES compared with those who had outgrown CM-FPIES, as documented by OFC; there was no change in tryptase after OFC Increased TNF-α and decreased expression of TGF-ß receptors, known to protect the intestinal barrier from the penetration of foreign antigen have been found in the intestinal mucosa of FPIES patients [97,100,110,111].…”

Section: Ip-10mentioning

confidence: 86%

“…Older studies reported proliferation of PBMCs upon stimulation with food allergen [49,50,58,[99][100][101][102][103].…”

Section: Ip-10mentioning

confidence: 99%

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Food Protein–Induced Enterocolitis Syndrome

Nowak‐Węgrzyn

Jarocka-Cyrta

Castro

2017

J Investig Allergol Clin Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES. Key words: FPIES. Food protein-induced enterocolitis syndrome. Non-IgE-mediated food allergy. Food allergy. Cow milk allergy. ResumenSEIOA es una alergia alimentaria con patofisiología y prevalencia desconocidas, que típicamente comienza en el primer año de vida, mientras que la producida por pescado suelo tener su comienzo en adultos. La forma aguda se manifiesta entre la hora y 4 horas tras la ingesta del alimento con emesis, palidez, letargia progresiva por deshidratación y shock hipovolémico en el 15% de los casos. La forma crónica se manifiesta con emesis intermitente, diarreas y crecimiento pobre con progresión hacia la deshidratación y shock hipovolémico en un periodo de días o semanas. La forma crónica se ha podido observar únicamente en niños menores de 3 años alimentados con leche de vaca o fórmula de soja. Los desencadenantes más frecuentes son la leche de vaca, la soja, el arroz y avena. El diagnóstico es clínico y puede ser difícil debido a la ausencia de síntomas alérgicos típicos (urticaria, asma…) y a la relación retardada con la ingesta. Es recomendable la provocación controlada si el diagnóstico clínico o el alimento implicado no son claros y tamb...

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The threshold for immune cell reactivity to milk antigens decreases in cow’s milk allergy with intestinal symptoms

Cited by 55 publications

References 21 publications

Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome

Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome

Food protein-induced enterocolitis syndrome: Case presentations and management lessons

Food Protein–Induced Enterocolitis Syndrome

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