Food protein‐induced enterocolitis syndrome caused by fish and/or shellfish in <scp>I</scp>taly

Sopo, Stefano Miceli; Monaco, Serena; Badina, Laura; Barni, Simona; Longo, Giorgio; Novembre, Elio; Viola, S; Monti, Giovanna

doi:10.1111/pai.12461

Cited by 82 publications

(56 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The threshold dose could be a normal serving size or a very minute quantity, although it is thought that it is generally in the gram range [16, 17]. Sopo et al [8] did not find any differences in the severity of the symptoms developed after the first dose or after the whole serving was given, so they suggested that the quantity of fish ingested did not appear to be correlated with the severity of the symptoms presented. However, our results support the idea that the symptoms do correlate with the amount of fish ingested.…”

Section: Discussionmentioning

confidence: 99%

“…The OFC is not risk free and many patients develop severe symptoms after this procedure. There is no generally accepted protocol to perform the OFC, and several ways to do it have been described [4, 7, 8]. The International Consensus Guidelines for the Diagnosis and Management of Food Protein-Induced Enterocolitis Syndrome recommends administering the challenging food at a dose of 0.06–0.6 g, usually 0.3 g of the food protein per kilogram of body weight, in 3 equal doses over 30 min.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

Infante

Martín

Zubeldía

et al. 2019

Int Arch Allergy Immunol

View full text Add to dashboard Cite

Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow’s milk or soy. Among the solid foods, rice is one of the most causative foods worldwide, but it varies depending on the geographic area. In the Mediterranean countries, fish is one of the most important triggers of FPIES. There is not a specific biological marker for the disease that allows us to confirm the diagnosis or to predict when tolerance to the offending food has been achieved, so all patients with a FPIES diagnosis undergo an oral food challenge (OFC) at least once. The OFC is a risky procedure and many patients develop severe symptoms. Objective: We sought to evaluate the safety of a new OFC protocol in children with fish-FPIES. Methods: A retrospective study was performed over a 22-year period (1996–2018). We compared two methodologies used in the OFC: Method 1 that consisted in giving several doses during the same day versus Method 2 that consisted in giving a unique dose per day on 2 or three non-consecutive days. Results: A total of 75 positive OFC with fish done in 40 children were included. Forty-three (57.3%) OFC were performed following Method 1 and 32 (42.7%) with Method 2.The severity of the symptoms of the OFC done with Method 1 was mostly moderate (41.9%) followed by severe (39.5%) and mild (18.6%). The adverse reactions with Method 2 were mostly mild (68.8%) and only 18.8 and 12.5% presented moderate or severe symptoms, respectively. Conclusions: OFC performed in children with fish-FPIES are risky and many patients develop moderate or severe symptoms after this procedure. We propose a new protocol that has demonstrated to improve safety.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

Infante

Martín

Zubeldía

et al. 2019

Int Arch Allergy Immunol

View full text Add to dashboard Cite

show abstract

“…Reports of a series of infants with food protein-induced enterocolitis by Sicherer et al [11] (16 patients) and Burks et al [12] (43 patients) further characterized clinical features and refined food challenge protocols. More recent reports have identified various solid foods as triggers for FPIES [13][14][15][16][17][18]. Prior to implementation of the International Classification of Diseases, Tenth Revision (ICD-10) code for FPIES (K52.2) in October 2015, no uniform ICD code existed [19].…”

Section: Historical Perspectivementioning

confidence: 99%

“…FPIES caused by finned fish (eg, codfish, salmon, tuna) has been described as one of the most common triggers in infants and toddlers in Spain and Italy, likely reflecting the importance of fish in the diet and the relatively earlier age of introduction compared with other countries [14][15][16][39][40][41][42][43][44]. Table 2 presents the characteristics of fish-induced FPIES.…”

Section: Fpies Caused By Fishmentioning

confidence: 99%

Food Protein–Induced Enterocolitis Syndrome

Nowak‐Węgrzyn

Jarocka-Cyrta

Castro

2017

J Investig Allergol Clin Immunol

View full text Add to dashboard Cite

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES. Key words: FPIES. Food protein-induced enterocolitis syndrome. Non-IgE-mediated food allergy. Food allergy. Cow milk allergy. ResumenSEIOA es una alergia alimentaria con patofisiología y prevalencia desconocidas, que típicamente comienza en el primer año de vida, mientras que la producida por pescado suelo tener su comienzo en adultos. La forma aguda se manifiesta entre la hora y 4 horas tras la ingesta del alimento con emesis, palidez, letargia progresiva por deshidratación y shock hipovolémico en el 15% de los casos. La forma crónica se manifiesta con emesis intermitente, diarreas y crecimiento pobre con progresión hacia la deshidratación y shock hipovolémico en un periodo de días o semanas. La forma crónica se ha podido observar únicamente en niños menores de 3 años alimentados con leche de vaca o fórmula de soja. Los desencadenantes más frecuentes son la leche de vaca, la soja, el arroz y avena. El diagnóstico es clínico y puede ser difícil debido a la ausencia de síntomas alérgicos típicos (urticaria, asma…) y a la relación retardada con la ingesta. Es recomendable la provocación controlada si el diagnóstico clínico o el alimento implicado no son claros y tamb...

show abstract

“…Solid-food FPIES tends to start later than cow’s milk and soy FPIES, perhaps because solids are introduced later at around 6 months of age [10]. In an Italian study, the chief peculiarities of acute fish and shellfish FPIES [19], compared to more frequent cow’s milk or soy FPIES, were an older age of onset, longer persistence, possibility of tolerating fish other than the offending fish, and adverse reactions to shellfish.…”

Section: Food Protein-induced Enterocolitis Syndromementioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

Dupont¹

2018

Ann Nutr Metab

View full text Add to dashboard Cite

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.

show abstract

Food protein‐induced enterocolitis syndrome caused by fish and/or shellfish in Italy

Abstract: The chief peculiarities of acute fish and shellfish FPIES, compared to more frequent cow's milk or soy FPIES, are (i) later age of onset, (ii) longer persistence and (iii) possibility of tolerating fish other than the offending fish. Adverse reactions with shellfish are possible.

Cited by 82 publications

References 19 publications

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

Food Protein–Induced Enterocolitis Syndrome

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

Contact Info

Product

Resources

About