Clinical and immunological characteristics of a pediatric population with food protein‐induced enterocolitis syndrome (FPIES) to fish

González-Delgado, Purificación; Caparrós, Esther; Moreno, María Ángeles Esteban; Clemente, Fernando; Flores, Emilio; Velásquez, Laura; Rubio, Gonzalo; Fernández, J.

doi:10.1111/pai.12529

Cited by 65 publications

(62 citation statements)

References 29 publications

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“…Miceli et al in the past had suggested that FPIES as a diagnosis should be considered until at least 2 years of age. However, it is already recognized in the International Consensus Guidelines of FPIES that this diagnosis can occur later in childhood and that egg, fish and shellfish FPIES has been described in a small adult case series . There are significant limitations in regard to the published data on age of onset in FPIES due to it still being a poorly recognized disorder.…”

Section: The Natural Course Of Non‐ige‐mediated Gastrointestinal Allementioning

confidence: 99%

“…However, it is already recognized in the International Consensus Guidelines of FPIES that this diagnosis can occur later in childhood and that egg, fish and shellfish FPIES has been described in a small adult case series. 46,49,50 There are significant limitations in regard to the published data on age of onset in FPIES due to it still being a poorly recognized disorder. Ludman et al 44 found that patients with FPIES in the United Kingdom had a mean symptom duration for 20.2 months, before a referral to a specialist allergy centre was made.…”

Section: Food Protein-induced Enterocolitis Syndrome (Fpies)mentioning

confidence: 99%

“…Median age for milk tolerance in subjects with undetectable milk-specific IgE levels was 5.1 years (see below overlap with IgE-mediated allergies). In two recent studies on fish FPIES, tolerance was reported in 75% of children at around 5 years, and in the other, only 16% had achieved tolerance based on oral food challenge at 4.5 years, which may imply a longer time for tolerance acquisition for certain foods 50,55.…”

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confidence: 97%

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Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

Fox

Lozinsky

Michaelis

et al. 2019

Pediatric Allergy Immunology

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The rise in food allergy has been described as the “second wave” of the allergy epidemic, with some developed countries reporting a prevalence of 10% of challenge‐proven food allergies. Recognition of the Allergic March has played a crucial role in identifying causality in allergic conditions, linking atopic dermatitis to food allergy and food allergy to other atopic disorders, thereby highlighting opportunities in prevention and the importance of early intervention. This publication will establish the value of weaving the less well‐understood, non‐IgE‐mediated food allergy into the Allergic March and mapping its progression through childhood and its associated co‐morbidities. The proposed non‐IgE‐mediated Allergic March highlights the concomitant presentation of gastrointestinal symptoms and atopic dermatitis as early presenting symptoms in confirmed non‐IgE‐mediated allergies and the later development of atopic co‐morbidities, including asthma and allergic rhinitis, similar to the IgE‐mediated Allergic March. This publication highlights recent observations of a link between non‐IgE‐mediated food allergy in early childhood and functional gastrointestinal disorders in later life and also the reported occurrence of extra‐intestinal manifestations at later ages. Although significant limitations exist in regard to the proposed evolution of the Allergic March model, the authors hope that this publication will influence the management of non‐IgE‐mediated gastrointestinal allergies and inform future research and interventions.

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Section: The Natural Course Of Non‐ige‐mediated Gastrointestinal Allementioning

confidence: 99%

Section: Food Protein-induced Enterocolitis Syndrome (Fpies)mentioning

confidence: 99%

mentioning

confidence: 97%

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Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

Fox

Lozinsky

Michaelis

et al. 2019

Pediatric Allergy Immunology

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“…Among the solid foods, rice is considered one of the most common causative foods worldwide [1], but it varies depending on the geographic area. In the Mediterranean countries, such as Spain or Italy, fish is the most important solid food trigger of FPIES [2-5]. …”

Section: Introductionmentioning

confidence: 99%

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

Infante

Martín

Zubeldía

et al. 2019

Int Arch Allergy Immunol

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Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow’s milk or soy. Among the solid foods, rice is one of the most causative foods worldwide, but it varies depending on the geographic area. In the Mediterranean countries, fish is one of the most important triggers of FPIES. There is not a specific biological marker for the disease that allows us to confirm the diagnosis or to predict when tolerance to the offending food has been achieved, so all patients with a FPIES diagnosis undergo an oral food challenge (OFC) at least once. The OFC is a risky procedure and many patients develop severe symptoms. Objective: We sought to evaluate the safety of a new OFC protocol in children with fish-FPIES. Methods: A retrospective study was performed over a 22-year period (1996–2018). We compared two methodologies used in the OFC: Method 1 that consisted in giving several doses during the same day versus Method 2 that consisted in giving a unique dose per day on 2 or three non-consecutive days. Results: A total of 75 positive OFC with fish done in 40 children were included. Forty-three (57.3%) OFC were performed following Method 1 and 32 (42.7%) with Method 2.The severity of the symptoms of the OFC done with Method 1 was mostly moderate (41.9%) followed by severe (39.5%) and mild (18.6%). The adverse reactions with Method 2 were mostly mild (68.8%) and only 18.8 and 12.5% presented moderate or severe symptoms, respectively. Conclusions: OFC performed in children with fish-FPIES are risky and many patients develop moderate or severe symptoms after this procedure. We propose a new protocol that has demonstrated to improve safety.

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“…FPIES caused by finned fish (eg, codfish, salmon, tuna) has been described as one of the most common triggers in infants and toddlers in Spain and Italy, likely reflecting the importance of fish in the diet and the relatively earlier age of introduction compared with other countries [14][15][16][39][40][41][42][43][44]. Table 2 presents the characteristics of fish-induced FPIES.…”

Section: Fpies Caused By Fishmentioning

confidence: 99%

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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Clinical and immunological characteristics of a pediatric population with food protein‐induced enterocolitis syndrome (FPIES) to fish

Cited by 65 publications

References 29 publications

Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

Food Protein–Induced Enterocolitis Syndrome

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