Usefulness of Atopy Patch Test on a Child with Milk Protein-Induced Enterocolitis Syndrome: A Case Report

Scaparrotta, Alessandra; Pillo, Sabrina Di; Consilvio, Nicola Pietro; Attanasi, Marina; Cingolani, Anna; Rapino, Daniele; Cerasa, Marzia; Pucci, Neri; Gioacchino, Mario Di; Chiarelli, Francesco

doi:10.1177/039463201302600327

Cited by 9 publications

(13 citation statements)

References 26 publications

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“…Though the majority of patients with FPIES have undetectable serum IgE at the time of diagnosis, 18-30 % of FPIES patients may develop IgE mediated food sensitivity to the same food at some point during their course, with some developing immediate type symptoms of classic IgEmediated food allergy [8,24,29]. Gastric juice leukocytosis at 3 h after a food challenge and atopy patch testing with fresh foods (APT) have been investigated in FPIES patients [30][31][32][33]. However, the results are equivocal, and therefore their diagnostic utility remains unclear and they are not recommended for routine evaluation of FPIES [1,26].…”

Section: Diagnosismentioning

confidence: 99%

Non-IgE-Mediated Food Allergy: FPIES

Nowak‐Węgrzyn

Konstantinou

2014

Curr Pediatr Rep

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food hypersensitivity with usual onset in infancy. The most common FPIES triggers are cow milk, soy and rice; in addition, oats, vegetables, egg, poultry and seafood have been reported. In the acute form, when food is ingested on an intermittent basis or following a period of avoidance, FPIES presents with profuse vomiting within 1-3 h after ingestion, occasionally accompanied by diarrhea and dehydration. In the chronic form, when food is ingested on a regular basis, FPIES presents with intermittent vomiting, diarrhea, weight loss and failure to thrive. FPIES is diagnosed based on history and typical symptoms, which improve with food avoidance, and exclusion of other etiologies. Oral food challenge remains the gold standard for FPIES diagnosis. Most CM or soy FPIESs resolve within the first 3-5 years; solid food FPIES or FPIES associated with positive food-specific IgE may have a more protracted course. The prevalence of FPIES is unknown.

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Section: Diagnosismentioning

confidence: 99%

Non-IgE-Mediated Food Allergy: FPIES

Nowak‐Węgrzyn

Konstantinou

2014

Curr Pediatr Rep

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“…Several studies have suggested a key role for T cells in FPIES patients, particularly by founding positive patch test or positive lymphocyte transformation test to the specific food allergen 22–28. It has been suggested that secretion of proinflammatory cytokines TNF-α and IFN-γ, in combination with a relative lack of expression of TGF-β-receptors (known as a protector of the intestinal wall) may contribute to local inflammation and increased intestinal permeability 16,29–31.…”

Section: Introductionmentioning

confidence: 99%

Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management

Michelet¹,

Schluckebier²,

Petit³

et al. 2017

JAA

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Food protein-induced enterocolitis syndrome (FPIES) is a potentially severe presentation of non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) with heterogeneous clinical manifestations. Acute FPIES is typically characterized by profuse vomiting and lethargy, occurring classically 1–4 hours after ingestion of the offending food. When continuously exposed to the incriminated food, a chronic form has been described with persistent vomiting, diarrhea, and/or failure to thrive. Although affecting mainly infants, FPIES has also been described in adults. Although FPIES is actually one of the most actively studied non-IgE-GI-FAs, epidemiologic data are lacking, and estimation of the prevalence is based on a limited number of prospective studies. The exact pathomechanisms of FPIES remain not well defined, but recent data suggest involvement of neutrophils and mast cells, in addition to T cells. There is a wide range of food allergens that can cause FPIES with some geographical variations. The most frequently incriminated foods are cow milk, soy, and grains in Europe and USA. Furthermore, FPIES can be induced by foods usually considered as hypoallergenic, such as chicken, potatoes or rice. The diagnosis relies currently on typical clinical manifestations, resolving after the elimination of the offending food from the infant’s/child’s diet and/or an oral food challenge (OFC). The prognosis is usually favorable, with the vast majority of the case resolving before 5 years of age. Usually, assessment of tolerance acquisition by OFC is proposed every 12–18 months. Of note, a switch to an IgE-mediated FA is possible and has been suggested to be associated with a more severe phenotype. Avoiding the offending food requires education of the family of the affected child. A multidisciplinary approach including ideally allergists, gastroenterologists, dieticians, specialized nurses, and caregivers is often useful to optimize the management of these patients, that might be difficult.

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“…Хроническая форма возникает при ежедневном приеме пищи (например, кормление ребенка смесью на основе КМ или сои). Симптомы FPIES представлены перемежающейся рвотой, хронической диареей, недостаточной прибавкой веса или задержкой развития [26]. Младенцы с хроническим FPIES обычно возвращаются к своему обычному состоянию через 3-10 дней после перехода на смесь с полным гидролизом белка, однако иногда в тяжелых случаях может потребоваться внутривенное введение жидкости.…”

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Food protein-induced enterocolitis syndrome in pediatric practice

et al. 2019

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One of non-IgE-mediated disorders that pediatricians and allergologists have to deal with is food protein-induced enterocolitis syndrome (Food Protein Induced Enterocolitis Syndrome, FPIES). Cow milk and soy proteins are the most common cause of FPIES. Other foods that can cause FPIES include a wide range of solid food stuffs, such as grains, vegetables, fruits, and poultry. Food-borne enterocolitis is usually accompanied by acute recurring vomiting and diarrhea, lethargy, pallor, dehydration, and even hypovolemic shock. FPIES often occurs after the first introduction of complementary foods containing trigger products, usually not accompanied by fever or a significant increase in the level of C-reactive protein, and generally has a good prognosis. Depending on the severity of the disease, metabolic acidosis and meth-hemoglobinemia may develop. In chronic cases anemia, hypoalbuminemia and eosinophilia may occur. In acute cases laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking 6 hours after a meal. Manifestations of FPIES usually disappear within 24-48 hours after elimination of the causative food. Radiological evaluation and other methods like endoscopy and gastric juice analysis can yield nonspecific results. Data on the incidence of FPIES is limited, and approximate assessment of affected children rate varies from 1.5 to 30 per 10,000. Further studies are needed to identify clinical subtypes and predisposing factors for the development of FPIES compared to immediate-type IgE-mediated gastroenteropathy.

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Usefulness of Atopy Patch Test on a Child with Milk Protein-Induced Enterocolitis Syndrome: A Case Report

Cited by 9 publications

References 26 publications

Non-IgE-Mediated Food Allergy: FPIES

Non-IgE-Mediated Food Allergy: FPIES

Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management

Food protein-induced enterocolitis syndrome in pediatric practice

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Usefulness of Atopy Patch Test on a Child with Milk Protein-Induced Enterocolitis Syndrome: A Case Report

Cited by 9 publications

References 26 publications

Non-IgE-Mediated Food Allergy: FPIES

Non-IgE-Mediated Food Allergy: FPIES

Food protein-induced enterocolitis syndrome &ndash; a review of the literature with focus on clinical management

Food protein-induced enterocolitis syndrome in pediatric practice

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Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management