Food Protein-Induced Enterocolitis Syndrome

Nowak‐Węgrzyn, Anna; Berin, M. Cecilia; Mehr, Sam

doi:10.1016/j.jaip.2019.08.020

Cited by 130 publications

(186 citation statements)

References 56 publications

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“…It is hypothesized that the ingestion of food allergens causes a T-cell mediated response that results in local in ammation leading to increased intestinal permeability and uid shift (14). There may also be a role for transforming growth factor beta (TGF-β) receptors, activated peripheral blood monocular cells, and increased tumor necrosis factor (TNFα) alpha in the intestinal mucosa involved in intestinal in ammation (15). Ondansetron has been shown to be bene cial in the treatment of FPIES in children, though the mechanism is unclear (16).…”

Section: Discussionmentioning

confidence: 99%

Adults with Possible Food Protein-Induced Enterocolitis Syndrome with Crustacean Ingestion

Wong-Pack

Macikunas

et al. 2020

Preprint

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Background: Food protein-induced enterocolitis (FPIES), an entity previously thought to only affect children, has been increasingly described in adults. In this study, we report a Canadian cohort of 19 adolescents and adults with recurrent non-immunoglobulin E (IgE) -mediated gastrointestinal symptoms after crustacean ingestion, consistent with FPIES.Methods: We conducted a retrospective chart review of patients in an outpatient allergy clinic from January 2005 to May 2020. Electronic records were searched using keywords for crustaceans and for symptoms consistent with FPIES. We included patients with gastrointestinal symptoms specifically to crustaceans on more than one occasion, who were 14 years or older at the time of index reaction. Exclusion criteria included symptoms suggestive of an IgE-mediated anaphylactic reaction or a likely alternative diagnosis. We identified 19 patients for our cohort who met the criteria.Results: Our cohort was 68.4% female (13) and 32.6% (6) male. The average age at first reaction to crustaceans was 34 years old with a range of 14 years to 68 years (median = 28 years; IQR = 32 years). Time from ingestion to beginning of symptoms ranged from 3 minutes to 6.5 hours, with an average of 2.8 hours (median = 2 hours; IQR = 3.25 hours). Duration of reaction ranged from less than a minute to over 48 hours, with a mean of 9.4 hours (median = 4 hours; IQR= 7.75 hours). Patients had 4.8 reactions on average; however, number of reactions ranged from 2 to 12.5 (median = 3, IQR = 3). All patients identified a “trigger” food in the crustacean group, and 12 subjects identified additional reactions to other seafood. Conclusions: We hope our case series will better characterize and advance our understanding of this disease entity in adults. There are key differences in the presentation of FPIES in adults compared to children, namely female predominance, difference in solid food trigger, and unpredictable time course. Future studies are needed to examine the pathophysiology and natural history of adult FPIES. Specific guidelines should be developed for the diagnosis and management in adults.Trial Registration: retrospectively registered

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Section: Discussionmentioning

confidence: 99%

Adults with Possible Food Protein-Induced Enterocolitis Syndrome with Crustacean Ingestion

Wong-Pack

Macikunas

et al. 2020

Preprint

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“…Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms [11][12][13]. Fish is one the most frequent triggers of FPIES in Mediterranean countries [14].…”

Section: Clinical Aspects Of Fish Allergymentioning

confidence: 99%

What Do We Know About Fish Allergy at the End of the Decade?

Kourani¹,

Corazza²,

Michel³

et al. 2019

J Investig Allergol Clin Immunol

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Fish allergy is one of the most common food allergies. It is usually considered to be IgE-mediated and correlates well with diagnostic tests such as prick tests and/or determination of specific IgE. Avoidance is the recommended treatment and is generally extended to all fish species. However, new clinical presentations have been described. These include non-IgE-mediated disease, monosensitization, and new syndromes that are sometimes associated, surprisingly, with cross-reactivity. Advances in molecular allergy have provided insights into new allergens and have increased our understanding of cross-reactivity. This paper focuses on recent publications providing information for clinicians involved in the management of fish allergy.

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“…Strict avoidance of the trigger food is the cornerstone of long-term management. After elimination of the offending food, acute FPIES usually resolves within 4-12 hours, whereas chronic FPIES resolves within 3 to 10 days [59].…”

Section: Long-term Management and Prognosismentioning

confidence: 99%

“…Children with CM-or soy-induced FPIES may also be more likely to react to solid foods, mainly rice and oat, and although grains, legumes, and poultry should be avoided in the first year of life [62], current early feeding guidelines do not recommend delaying the introduction of complementary foods after 6 months of life because of a history of previous FPIES [46]. A sequence for introducing solid foods after 6 months of age starting with fruits and vegetables followed by red meats and then cereal grains (considering poultry, banana, green pea, rice, and oat as high risk foods) has been proposed [46,59]. Sopo et al [46] propose supervised OFCs to various solids as a way of excluding the risk of severe reactions to small amounts, followed by gradual build-up to regular age-appropriate servings at home.…”

Section: Long-term Management and Prognosismentioning

confidence: 99%

Latest Insights on Food Protein–Induced Enterocolitis Syndrome: An Emerging Medical Condition

Sexto¹

2018

J Investig Allergol Clin Immunol

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Food protein-induced enterocolitis syndrome (FPIES) is a type of non-IgE-mediated gastrointestinal food hypersensitivity characterized by profuse vomiting that is frequently associated with pallor or/and lethargy and appears within 1 to 3 hours after ingestion of the offending food. A less frequent chronic form of FPIES is characterized by protracted vomiting, diarrhea, or both accompanied by poor growth. Although FPIES is considered a rare allergic disorder, increasing reports in recent years point to a real increase in incidence, or at least an increased awareness of this condition by pediatricians. The foods most frequently implicated are cow's milk, soy formula, grains, and fish, depending on the geographic area. Diagnosis is based on clinical manifestations and requires a high index of suspicion, since we still lack a diagnostic laboratory tool. Early recognition of FPIES and removal of the offending food are mandatory. International consensus guidelines on diagnosis and management have been published. Prognosis is usually good, with most children tolerating foods before 6 years of age.

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Food Protein-Induced Enterocolitis Syndrome

Cited by 130 publications

References 56 publications

Adults with Possible Food Protein-Induced Enterocolitis Syndrome with Crustacean Ingestion

Adults with Possible Food Protein-Induced Enterocolitis Syndrome with Crustacean Ingestion

What Do We Know About Fish Allergy at the End of the Decade?

Latest Insights on Food Protein–Induced Enterocolitis Syndrome: An Emerging Medical Condition

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