Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy

Abstract

Food protein-induced enterocolitis (FPIES), allergic proctocolitis (FPIAP), and enteropathy (FPE) are among a number of immune-mediated reactions to food that are thought to occur primarily via non-IgE-mediated pathways. All three are typically present in infancy and are triggered most commonly by cow's milk protein. The usual presenting features are vomiting with lethargy and dehydration in FPIES; bloody and mucous stools in FPIAP; and diarrhea with malabsorption and failure to thrive in FPE. Diagnosis is based on convincing history and resolution of symptoms with food avoidance; confirmatory diagnostic testing other than food challenge is lacking. The mainstay of management is avoidance of the suspected inciting food, with interval challenge to assess for resolution, which usually occurs in the first years of life. Studies published in the past few years clarify common presenting features, report additional culprit foods, address potential biomarkers, and suggest new management strategies.

The prevalence and characteristics of cow's milk protein allergy in infants and young children with iron deficiency anemia

“…In this study, we described a group of infants and young children with CMPA who sought clinical help initially due to pale-looking. 13 The phenotype of CMPA is classified into immediate reactions and delayed reactions, depending on the timeline between allergen ingestion and symptoms occurrence or immunologic reaction. 12,14 Immediate reactions are mostly IgE-mediated and require only minutes up to 2 h after CMP ingestion.…”

Estudio de validez diagnóstica de la prueba de hemorragia oculta fecal en lactantes con proctocolitis alérgica inducida por proteína alimentaria

“…It has been proposed that delayed maturation of the gastrointestinal immune system leads to the food hypersensitivity that characterizes FPIAP 19 . Therefore, histopathological alterations in the rectosigmoid colon of affected infants are generally sought.…”

“…Considering the above background, and as recom-mended by national and international guidelines, in the absence of objective diagnostic tests, the correct way to make the diagnosis of FPIAP is through a 2-4 week elimination diet and then an oral food challenge test 4,5,15 . The latter can be performed at home for infants with FPIAP, unlike IgE-mediated FA or food protein-induced enterocolitis syndrome 19 . As this study addresses the diagnostic validity of FOBT, only infants with rectal bleeding and high suspicion of FPIAP were recruited, excluding infants with possible FPIAP who did not have macroscopic gastrointestinal bleeding.…”

Optimizing an Aversion Feeding Therapy Protocol for a Child with Food Protein-Induced Enterocolitis Syndrome (FPIES)

“…Though the prognosis for children with FPIES is favorable, in that it typically resolves by 3-5 years of age [1,10,11] the impact of the disorder results in decreased opportunities to practice oral motor skill development with a variety of foods and can result in learned feeding aversion. Even in children with nonorganic feeding problems who are still able to thrive nutritionally, negative behaviors around feeding can result in a greater risk for poor health, social and emotional problems, nutrient deficiencies, social problems, and disruption of family life [12].…”

“…Though a separate clinical entity, eosinophilic gastroenteropathies share many overlapping clinical and histological features with the non-IgE gastrointestinal food allergies [11]. EGs include eosinophilic proctocolitis (EP), eosinophilic gastroenteritis (EG), and eosinophilic esophagitis (EoE).…”