Efficacy of oral ondansetron in acute FPIES: A case series of 6 patients

Le, Sébastien; Boissieu, D. de; Garcelon, Nicolas; Lageix, Florence; Bodilis, Hélène; Branellec, A; Karila, C.; Faour, Hassan; Delacourt, Christophe; Lezmi, Guillaume

doi:10.1111/all.14335

Cited by 14 publications

(2 citation statements)

References 9 publications

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“…For that reason, we may suggest that patients with DIES could benefit from oral ondansetron in order to treat quickly potential recurrences with other related or unrelated drugs. In six FPIES cases, Le and al 17 reported that oral ondansetron may be useful for children, at least before they reach emergency room departments. So far, the patients with DIES recovered completely after the acute phase and no fatal cases have been described.…”

Section: What Do We Already Know About Dies?mentioning

confidence: 99%

Drug‐induced enterocolitis syndrome: Similarities and differences compared with food protein‐induced enterocolitis syndrome

Mori

Liccioli

Fuchs

et al. 2021

Pediatric Allergy Immunology

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Drug-induced enterocolitis syndrome (DIES) is the term used to describe reactions occurring after drug exposure. It is a non-IgEmediated hypersensitivity reaction, characterized by symptoms that typically resemble those of FPIES (food protein-induced enterocolitis syndrome). It is a rare and probably underestimated entity, since very few cases have been reported in literature so far. To date, seven cases of DIES have been described, four in children, [1][2][3][4] one in an 18-year-old male patient, 5 and two in adult patients. 6,7 In 2014, Novembre et al 1 described the case of a 6-year-old girl who developed gastrointestinal symptoms of vomiting, diarrhea, pallor, and lethargy 2 hours after a drug provocation test (DPT) with amoxicillin (AMX). As the clinical and laboratory features, that is, vomiting, neutrophilia, methemoglobinemia (MethHb), and need for intravenous fluid support, resembled those of FPIES, the term DIES was proposed for the first time. In the following, five other cases of DIES have been reported, summarized in Table 1.

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Section: What Do We Already Know About Dies?mentioning

confidence: 99%

Drug‐induced enterocolitis syndrome: Similarities and differences compared with food protein‐induced enterocolitis syndrome

Mori

Liccioli

Fuchs

et al. 2021

Pediatric Allergy Immunology

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“…1 Ondansetron is a serotonin 5-HT3 receptor antagonist and is reported to improve emesis that may occur in the FPIES OFC. [61][62][63] However, in some countries, including Japan, ondansetron is not covered by insurance as a treatment for vomiting caused by FPIES. The efficacy of domperidone, frequently used to treat vomiting in children with gastroenteritis, is unknown.…”

Section: Emergency Managementmentioning

confidence: 99%

Food Protein-induced Enterocolitis Syndrome

Akashi

2023

Keio J. Med.

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Food protein-induced enterocolitis syndrome (FPIES) is a type of non-IgE-mediated gastrointestinal food allergy. FPIES is characterized by repetitive vomiting without classic IgE-mediated allergic skin or respiratory symptoms 1-4 h after causative food ingestion. The condition may be classified as acute or chronic, typical or atypical, and liquid or solid according to the course of symptoms, presence of IgE antibodies, and causative food, respectively. Since the development of international consensus guidelines in 2017, epidemiological studies have been conducted in many countries. FPIES is a relatively rare disease, with a prevalence of 0.015%-0.7%. However, the number of patients has been increasing in recent years. Most patients develop the disease in infancy. The natural history of FPIES is generally favorable, with most FPIES cases resolving before school age. FPIES is diagnosed using symptoms such as vomiting or diarrhea, or via an oral food challenge (OFC). Currently, no validated biomarker is available for diagnosis, and the mechanisms related to gastrointestinal manifestations and immune system involved in the development of FPIES have not yet been elucidated. Treatment with intravenous fluids and ondansetron is recommended in the acute phase. Long-term management consists of complete causative food elimination and periodic OFC to confirm tolerance. Given that many diagnoses are delayed because of a lack of awareness of the condition, FPIES must be widely recognized by healthcare providers. In the future, it is expected that FPIES pathogenesis will be further clarified, and more objective diagnostic criteria will be developed.

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