Food Protein‐induced Enterocolitis Syndrome

Abstract

Objective: The aim of the study was to describe clinical, epidemiological, and management characteristics of food protein-induced enterocolitis syndrome (FPIES) cases in Spain. Patients and Methods: Multicenter observational retrospective study. FPIES cases diagnosed in specialized units in Spain over 12 months in 2017 (January–December) according to the recently published international diagnostic criteria were included. Results: One hundred twenty patients (53.3% boys) were included. The majority were acute cases (111) with mild-to-moderate severity (76.7%). Triggering foods were cow's milk (48/120), fish (38), egg (13), rice (12), and soy (1). The majority (84.2%) of the patients had FPIES to 1 food only. In addition to vomiting (100%), pallor (89.2%), and altered behavior (88.3%) were most frequently observed in acute forms. On the contrary, diarrhea (70%), abdominal distension (33.3%), and blood in stools (44.4%) were more frequently observed in chronic cases. Oral challenge was performed in 18.9% of the acute forms compared to 44.4% of the chronic forms. The most common treatment was intravenous fluids followed by ondansetron. Corticosteroids were used in 6 patients (5 with acute symptoms and 1 chronic). Seven patients were treated with antibiotics for suspicion of infection. Most cases of cow's milk FPIES were treated with extensively hydrolyzed formulas (69.8%). Conclusions: FPIES is not uncommon in our units. Unlike other published series, fish and egg are important triggers in our country. A greater knowledge and diffusion of the international consensus criteria will allow a better characterization of the cases and a standardization of their management.

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

“…Furthermore, we have not detected any correlation between the tested foods and the severity of the reactions during the OFC, similarly to Perry et al's study, 2 whereas in Jarvinen et al's study, 19 severity reactions were mainly associated with peanut and tree nuts.…”

Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

“…Rice and oats have emerged as the most common triggers in the USA, followed by cow's milk, soya, egg, fish, fruits, and vegetables [22]. In Italy and Spain, fish is the most common solid food trigger [25,26]. According to a recent international consensus, the diagnosis of FPIES requires the major criterion and at least 3 minor criteria to be met [6] (Table 2).…”

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

“…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].…”

“…* 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).…”

“…Diarrhea can also follow 5 to 10 h later, although this is a less common feature (25–50%). Infants often appear septic, presenting with symptoms of lethargy (65–100%), pallor (30–90%) and hypothermia (5%) [ 24 , 26 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. Symptoms may be quite severe, with up to 15% experiencing hemodynamic instability [ 65 , 68 ].…”