A Slice of Food Protein–Induced Enterocolitis Syndrome (FPIES): Insights from 441 Children with FPIES as Provided by Caregivers in the International FPIES Association

Maciag, Michelle C.; Bartnikas, Lisa M.; Sicherer, Scott H.; Herbert, Linda; Young, Michael C.; Matney, Fallon; Westcott-Chavez, Amity; Petty, Carter R.; Phipatanakul, Wanda; Bingemann, Theresa

doi:10.1016/j.jaip.2020.01.030

Cited by 45 publications

(46 citation statements)

References 17 publications

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“…Rice is the most commonly reported solid trigger in the United States and Australia, and may be associated with a more severe phenotype [63,[97][98][99]. Furthermore, other geographical variations are evident, such as the high prevalence of soy-induced FPIES in the United States [23,25,26,65,95], and of fish and shellfish reactions in Italy and Spain [20,40,60,76,100,101]. These are likely influenced by local dietary practices and may be the result of differences in genetic background [102].…”

Section: Reported Food Triggersmentioning

confidence: 99%

“…Co-atopic disease is highly overrepresented in patients with non-IgE-GI-FA, affecting 40–60% of FPIES patients [ 23 , 24 , 25 ], and up to 40–50% of FPE and FPIAP patients [ 12 , 17 ] ( Table 1 ). Likewise, a family history of atopy is present in as much as 60% and 80% of first-degree relatives in FPIAP and FPIES, respectively [ 21 , 24 , 26 , 27 ].…”

Section: Epidemiologymentioning

confidence: 99%

“… * Soy allergy likely underrepresented by these studies. 1 From Ruffner et al [ 95 ] ( n = 462), Caubet et al [ 26 ] ( n = 160), Blackman et al [ 65 ] ( n = 74), Maciag et al [ 25 ] ( n = 441), Su et al [ 64 ] ( n = 203); 2 From Ludman et al [ 66 ] ( n = 54); 3 From Vazquez-Ortiz [ 101 ] ( n = 81), Diaz et al [ 60 ] ( n = 120), Pérez Ajami et al [ 104 ] ( n = 135); 4 From Miceli Sopo et al [ 67 ] ( n = 66); 5 From Mehr et al [ 97 ] ( n = 35), Mehr et al [ 21 ] ( n = 230); 6 From Arik Yilmaz et al [ 105 ] ( n = 27); 7 From Kuitunen et al [ 28 ] ( n = 54); 8 From Lake et al [ 84 ] ( n = 95); 9 From Kaya et al [ 87 ] ( n = 60), Arik Yilmaz et al [ 105 ] ( n = 37), Erdem et al [ 86 ] ( n = 77), Cetinkaya et al [ 85 ] ( n = 185). …”

Section: Figurementioning

confidence: 99%

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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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Section: Reported Food Triggersmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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

2020

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“…The most common acute FPIES triggers include grains (particularly oat and rice), cow's milk, soy, egg, seafood, poultry, and select fruits/ vegetables. 13,[18][19][20][21]23,26,31,[34][35][36] Reports of acute FPIES to peanut seem to be increasing, possibly related to early introduction. 37 Geographic variation in the prevalence of individual FPIES triggers has been noted, and this is speculated to be related to differences in feeding practices.…”

Section: Food Triggersmentioning

confidence: 99%

The practical dietary management of food protein-induced enterocolitis syndrome

Groetch

Baker

Durban

et al. 2021

Annals of Allergy, Asthma & Immunology

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Food protein-induced enterocolitis syndrome (FPIES) is a non−immunoglobulin E-mediated food allergy with potential risk of malnutrition related to the early onset of disease, frequent avoidance of cow's milk, and the possibility of multiple food triggers. This publication is aimed at providing an evidence-based, practical approach to the dietary management of FPIES. Data Sources: This is a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to evaluate for nutritional risk and develop guidance for risk reduction in children with FPIES. Study Selections: We have included retrospective clinical cohort studies, population-based studies, case reports, and case studies. We did not exclude any studies identified owing to the small number of studies addressing the nutritional management of individuals with FPIES. Results: Children with FPIES are at risk of malnutrition owing to suboptimal oral intake, limited food choices, and knowledge deficits related to feeding. In particular, children with 3 or more FPIES triggers seem to be at increased risk for poor weight gain and developing food aversion. Caregivers of children with FPIES also report a high degree of psychosocial burden. Key MessagesSuboptimal oral intake, limited food choices, and knowledge deficits related to feeding have contributed to overt malnutrition and malnutrition risk for children with food protein-induced enterocolitis syndrome (FPIES).Children with FPIES to 3 or more foods are at increased risk of developing food aversion and having poor body weight gain.Caregivers of children with FPIES report a high degree of psychosocial burden.Dietary management of FPIES entails avoidance of allergens, supporting normal growth and development and advancement of complementary foods.Providing a detailed individualized feeding plan may help prevent feeding aversions and nutritional deficiencies and ease the burden on caregivers.

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“…2 Parenteral injection of ondansetron, a serotonin-receptor antagonist antiemetic, is often used to treat acute FPIES in moderate-severe reaction in hospital settings. [3][4][5][6][7][8] The parenteral formulation precludes home use. Thus, administration of ondansetron is often delayed in patients experiencing acute FPIES outside of the hospital setting.…”

Section: Efficacy Of Oral Ondansetron In Acute Fpies: a Case Series Omentioning

confidence: 99%