Half Cow's Milk-Induced Food Protein Induced Enterocolitis Syndrome (FPIES) Require Amino Acid Feeding

Abstract

RATIONALE: FPIES is mainly related to cow's milk and manifests as a chronic digestive disease or in its acute form with potentially lifethreatening vomiting/diarrhea/dehydration. The objective of this study is to characterize the clinical features of cow's milk-induced FPIES in children. METHODS: A cohort of patients with FPIES was constituted in French Children's Hospitals (Necker, Paris-Lenval, Nice). Data were collected from medical records including all patients referred for an acute episode of FPIES, and divided into 2 groups according to their tolerance of extensively hydrolysed formula (eHF) or their need to be fed an amino-acid formula (AAF). RESULTS: 49 children were enrolled. Chronic had occurred in 36 (73%), after a median period of 10 days following introduction of milkbased formula. In the whole group, the acute episode occurred at a median age of 4 months. Allergy testing was rarely positive: patch test 21 (51%), skin prick tests 3 (8%), specific IgE 13 (30%). Recovery was observed in 19 (40%) at a median age of 31 months. The eHF group comprised 24 (49%) infants and the AAF one 25 (51%). They exhibited the following significant or trend towards significance differences : number of hospitalizations before diagnosis per patient 0,9 vs 2,7 (p50,02), age of FA diagnosis 4,5 months vs 2,8 (p50,04), food tolerance acquisition 54% vs 24% (p50,02), associated FA 4% vs 48% (p50,0002). CONCLUSIONS: Half infants with milk-induced FPIES do not tolerate eHF, and need to be fed with an AAF, a condition associated with a delayed diagnosis.

Amino acid formulas in patients with food allergy

“…Так как в литературе описано достаточное количество случаев развития энтероколита именно на соевый белок, смеси на его основе не могут быть рекомендованы в качестве рутинного метода терапии [41,42]. В недавних исследованиях было показано, что в 10-40% случаев ВГС не работают при FPIES, а при острой форме этот показатель приближается к 50%, что делает более предпочтительным применение у данной группы пациентов АКС [43,44]. В ряде международных рекомендаций, таких как Международный консенсус по диагностике и ведению детей с FPIES, IMAP, BSACI, при наличии у детей сопутствующей задержки физического развития показано применение АКС [9,21].…”

Food Protein-Induced Enterocolitis Syndrome and Proctocolitis

“…Breastmilk is the best, as usual. Formula feeding relies mainly on extensively hydrolyzed milk protein formula or on amino-acid formulas, which are requested by one half of patients with milk FPIES [39]. In case of chronic cow’s milk and/or soy FPIES, symptoms resolve rapidly, within 1 week, often within 3 days of starting the elimination diet.…”