Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome

Feuille, Elizabeth; Nowak‐Węgrzyn, Anna

doi:10.1097/aci.0000000000000055

Cited by 44 publications

(39 citation statements)

References 52 publications

(37 reference statements)

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“…With stage 1 NEC, necrosis is implied by the name but is not validated with clear diagnostic criteria, which leads one to suspect that NEC is not yet present but may be developing. Another entity becoming increasingly recognized in older infants but with a poorly described pathophysiology, food protein-induced enterocolitis syndrome (FPIES), exhibits signs and symptoms similar to those in many preterm infants of NEC [8]. It will be critical to find ways to discern this entity from NEC since the treatment may be very different.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Enterocolitis: The Mystery Goes On

Neu

2014

Neonatology

125

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Necrotizing enterocolitis (NEC) has largely been present in neonatal intensive care units for the past 60 years. NEC prevalence has corresponded with the continued development and sophistication of neonatal intensive care. Despite major efforts towards its eradication, NEC has persisted and appears to be increasing in some centers. The pathophysiology of this disease remains poorly understood. Several issues have hampered our quest to develop a better understanding of this disease. These include the fact that what we have historically termed ‘NEC' appears to be several different diseases. Animal models that are commonly used to study NEC pathophysiology and treatment do not directly reflect the most common form of the disease seen in human infants. The pathophysiology appears to be multifactorial, reflecting several different pathways to intestinal necrosis with different inciting factors. Spontaneous intestinal perforations, ischemic bowel disease secondary to cardiac anomalies as well as other entities that are clearly different from the most common form of NEC seen in preterm infants have been put into the same database. Here I describe some of the different forms of what has been called NEC and make some comments on its pathophysiology, where available studies suggest involvement of genetic factors, intestinal immaturity, hemodynamic instability, inflammation and a dysbiotic microbial ecology. Currently utilized approaches for the diagnosis of NEC are presented and innovative technologies for the development of diagnostic and predictive biomarkers are described. Predictions for future strategies are also discussed.

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Section: Introductionmentioning

confidence: 99%

Necrotizing Enterocolitis: The Mystery Goes On

Neu

2014

Neonatology

125

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“…A decrease in prevalence was documented in Finland 48 and Spain 49 and attributed to a rise in breastfeeding and/or the use of adapted infant formula. [18][19][20] Removal of the causal protein leads to resolution of symptoms but re-exposure results in a characteristic delayed (by about 1 to 3 hours) onset of repetitive, often projectile vomiting, lethargy, elevation of the peripheral blood polymorphonuclear leukocyte count and possibly reduced temperature, thrombocytosis, hypotension, diarrhea, dehydration, acidemia and methemoglobinemia. [50][51][52] Unlike gluten-sensitive enteropathy (celiac disease), this enteropathy generally resolves in 1 to 2 years, and there is no increased threat of future malignancy.…”

Section: Dietary Protein Enteropathymentioning

confidence: 99%

Enterocolitis, Proctocolitis and Enteropathies

Sicherer¹,

Nowak‐Węgrzyn²

2016

Pediatric Allergy: Principles and Practice

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“…Very frequently, FPIES is not recognized at the first visit, whether in its chronic or acute form; owing to both the lack of associated typical cutaneous and respiratory allergic symptoms [28] and the lack of knowledge of this “emerging” syndrome among physicians [29-32]. This lack of knowledge includes the common belief that rice, oat, and vegetables are hypoallergenic and can never induce an allergic reaction.…”

Section: Food Protein-induced Enterocolitis Syndromementioning

confidence: 99%

“…History-taking is key for the diagnosis of FPIES, analyzing the clinical features, excluding other etiologies, and preparing the food challenge [28]. …”

Section: Food Protein-induced Enterocolitis Syndromementioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

Dupont¹

2018

Ann Nutr Metab

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Non-IgE-mediated, also labeled cell-mediated, allergic reactions to foods are more common than usually thought and probably account for approximately more than 40% of cases of cow’s milk allergy during infancy and young childhood. Food allergy is now described in the form of syndromes, among which food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP) are gaining increased recognition. FPIES occurs in infancy but may also occur in older children and in adults. The dominant symptom is emesis, repetitive in the chronic FPIES form and explosive in the acute form. Acute FPIES begins 1– 4 h following ingestion of the offending food. Diarrhea is frequent, between 5 and 10 h later, and may be accompanied by lethargy and dehydration, which both characterize severity. Cow’s milk is the most frequent food trigger, followed by soy. FPIES may develop up to 1 year of age, but may also occur in the newborn, and is possible in exclusively breastfed infants, in relation with the mother’s consumption of offending foods. FPIES may occur to solid foods (grains like rice or oat, meats, fish, egg, and vegetables). When starting during infancy, FPIES has a good prognosis and disappears grossly at 2 years of age. FPIES to fish or shellfish is more frequent in older children and adults and is long lasting. International consensus guidelines for the diagnosis and management of FPIES have been published recently. FPIAP starts in the first few months of life and is typically manifested with rectal bleeding in well-appearing breastfed infants during the first months of life in reaction to cow’s milk consumed by the mother. The condition is transient but represents one of the major causes of colitis during infancy.

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Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome

Cited by 44 publications

References 52 publications

Necrotizing Enterocolitis: The Mystery Goes On

Necrotizing Enterocolitis: The Mystery Goes On

Enterocolitis, Proctocolitis and Enteropathies

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

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