Tolerability of baked milk consumption in children with food protein-induced enterocolitis syndrome

Faitelson, Yoram; Yoffe, Siril; Segal, N; Marcus, Nufar; Greenbaum, Eris; Shahar-Nissan, Keren; Beigelman, Avraham

doi:10.1016/j.jaip.2022.10.013

Cited by 7 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 26 In a subset of patients with mild FPIES phenotype, baked egg and milk may be tolerated and introduction of baked foods would improve nutritional choices for the patient who is affected. 38 , 39 If breast-feeding, the maternal diet does not need to be restricted unless the infant is symptomatic with acute or chronic symptoms or not thriving. In cow’s milk or soy FPIES, hypoallergenic formula (Extensively Hydrolyzed Formula or Amino Acid) (up to 40%) may be used.…”

Section: Management Of Food Protein – Induced Ente...mentioning

confidence: 99%

Food protein-induced enterocolitis syndrome (FPIES): Beyond the guidelines

Shah,

Grohman,

Nowak-Wegrzyn

2023

Journal of Food Allergy

View full text Add to dashboard Cite

Background: Food protein‐induced enterocolitis syndrome (FPIES) is a non‐immunoglobulin E (IgE) cell mediated food allergy that can cause severe symptoms and is considered an allergic emergency. Objective: To describe FPIES epidemiology and appraise the approach to diagnosis and management. Methods: A review of the relevant articles published in the peer-reviewed journals since the publication of the First International FPIES Consensus Guidelines in 2017. Results: FPIES is estimated to affect 0.51‐0.9% of children and 0.22% of adults in the United States. It typically presents with protracted, projectile vomiting, which occurs within 1‐4 hours of ingesting culprit foods, sometimes followed by diarrhea within 24 hours of ingestion. In ∼15‐20% of severe cases, patients go into hypovolemic or distributive shock. In chronic FPIES, infants may have failure to thrive and weight loss. The most common triggers include cow’s milk, oat, rice, and avocado, with egg and peanut being more frequently reported. Examples of other common fruit and vegetable triggers include banana, apple, and sweet potato. FPIES can be classified into acute, chronic, adult-onset, or atypical subtypes. FPIES is associated with comorbid atopic conditions of IgE-mediated food allergy, atopic dermatitis, asthma, allergic rhinitis, and eosinophilic esophagitis. The natural history of infantile FPIES is generally favorable, with the exception of fish FPIES. Seafood FPIES in adults has low rates of resolution over 3‐5 years. Correctly identifying FPIES can be challenging because there are no specific biomarkers for diagnosis and the constellation of symptoms may mimic those of infectious enteritis or sepsis. Management relies on dietary food avoidance, periodic re-evaluations for tolerance with oral food challenges, and management of acute reactions with rehydration and antiemetic ondansetron. Although the pathophysiology of FPIES remains poorly understood, underlying mechanisms such as cytokine release, leukocyte activation, and impaired gastrointestinal mucosal barrier function may act as cornerstones for further research. Conclusion: Prevention, laboratory diagnostic testing, and strategies to accelerate tolerance development are urgent unmet needs in FPIES.

show abstract

Section: Management Of Food Protein – Induced Ente...mentioning

confidence: 99%

Food protein-induced enterocolitis syndrome (FPIES): Beyond the guidelines

Shah,

Grohman,

Nowak-Wegrzyn

2023

Journal of Food Allergy

View full text Add to dashboard Cite

show abstract

“…Current recommendations advise strict avoidance of the FPIES trigger in all forms, with re‐introduction of the food 12–24 months later in an observed OFC. A small recent cohort study 67 did report a majority of participants (8 of 11) had a negative baked milk OFC within 6 months of their most recent non‐baked CM reaction. Should further studies offer similar results, baked challenges for CM and HE may be considered in FPIES.…”

Section: Introductionmentioning

confidence: 99%

Dietary management of IgE and non‐IgE‐mediated food allergies in pediatric patients

Venter,

Roth‐Walter,

Vassilopoulos

et al. 2024

Pediatric Allergy Immunology

View full text Add to dashboard Cite

Food allergies (FA) consist of both IgE and non‐IgE‐mediated entities, with varying phenotypes and overlapping and different considerations for each specific disease presentation. In general, all FAs place children at increased risk for inadequate nutritional intake and negative impacts on their nutritional status, as well as negative impacts on the quality of life for the entire family. To minimize these untoward effects, a multidisciplinary approach should be taken, including consultation and management with a dietitian trained in the varying presentations of FA. Families should be instructed on label reading as a first line of nutritional management. During a nutrition consultation, the age of the child, growth, and nutritional status should be considered. Food refusal should be assessed and addressed. Families should be educated on avoidance and appropriate substitutions. In the case of cow's milk allergy, a suitable specialized formula should be suggested if the infant is not breastfed or if breast milk supply is not sufficient. Other mammalian milk should be avoided and careful consideration should be given before plant‐based milk is used in young children. Specific food allergies may differ in terms of advice provided on the level of avoidance required, whether precautionary advisory labels should be avoided, and if a maternal avoidance of the allergen during breastfeeding should be advised. The role of immunonutrition on overall health should be discussed.

show abstract