Phenotypes and natural history of food protein‐induced enterocolitis syndrome in the east Mediterranean region

Ocak, Melike; Akarsu, Ayşegül; Şahiner, Ümit Murat; Soyer, Özge

doi:10.2500/aap.2020.41.200078

Cited by 14 publications

(17 citation statements)

References 24 publications

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“…Limited data suggest that atypical FPIES with positive specific IgE is associated with delayed tolerance 6,8,16 . This was not confirmed in our study population, like in the recent Swedish 29 and Greek cohorts, 44 although sensitization (IgE and/or SPT; 14.7%) were similar compared to other studies (11.1%–34%) 10,11,18,22,25,26 . Atopic disorder was found in 41% of patients and eczema in 29%.…”

Section: Discussioncontrasting

confidence: 87%

“…This may result from the use of stringent criteria for the diagnosis of FPIES and the retrospective design of the study. Despite medical charts studied, for multiple FPIES in 13.4% of cases as per other series, 13,17,25,27,29‐31 we only retained FPIES with a specific clinical description. The prevalence of multiple FPIES ranges from 5.1% 19 to 69.0% 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite medical charts studied, for multiple FPIES in 13.4% of cases as per other series, 13,17,25,27,[29][30][31] we only retained FPIES with a specific clinical description. The prevalence of multiple FPIES ranges from 5.1% 19 to 69.0%.…”

Section: Discussionmentioning

confidence: 99%

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Food protein‐induced enterocolitis syndrome: A large French multicentric experience

Lemoine¹,

Colas

et al. 2022

Clinical & Translational All

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Background Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE‐mediated food allergy, with potential dehydration secondary to vomiting. Differences exist regarding culprit foods, and age of tolerance depending on the country of origin. We aimed at describing the characteristics of a French population of children with FPIES, and define risk factors for failure during challenge. Methods Data from 179 children who were referred for FPIES in two pediatric tertiary centers between 2014 and 2020 were retrospectively collected. The diagnosis of FPIES was based on international consensus guidelines. Clinical characteristics, culprit food, and age at resolution were assessed. Tolerance was defined as no adverse reaction after OFC or accidental exposure. Results In the 192 described FPIES, the age at first symptoms was 5.8 months old. The main offending foods were cow's milk (60.3%), hen's egg (16.2%), and fish (11.7%). Single FPIES was observed in 94.4% and multiple FPIES in 5.6% of cases. The age at resolution of FPIES was 2.2 years old, and resolution occurred later for fish than for milk (2.9 years vs. 2.0, p = 0.01). Severe acute FPIES was a risk factor for delayed resolution (RR: 3.3 [1.2–9.2]), but not IgE sensitization. Performing a food challenge within 12 months after the first reaction increased the risk of failure (OR: 2.6 [1.1–6.6]). Conclusion In this French cohort of children with FPIES, the main culprit foods were ubiquitous. Rice, oat, and soy were rarely or not involved. Multiple FPIES was infrequent. Our data confirmed the overall good prognosis of FPIES, the later resolution of FPIES to fish and in the case of severe acute FPIES.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Food protein‐induced enterocolitis syndrome: A large French multicentric experience

Lemoine¹,

Colas

et al. 2022

Clinical & Translational All

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“…In our study, the main culprit food was CM, followed by hen's egg, and fish, which differs from the findings in other countries. [7][8][9][10][11][12] The most frequent culprit food was fish in Greece 13 and Spain 10,14 rice in Australia [15][16][17] and the USA, 18 and oats in Taiwan. 19 Soy is frequently reported as a trigger food by North American, British, Australian and Israeli cohorts 4,17,20,21 and was infrequent in our population.…”

Section: Discussionmentioning

confidence: 99%

Food protein-induced enterocolitis syndrome: a large French multicentric experience

Lemoine¹,

Colas²,

et al. 2021

Preprint

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Background Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated food allergy, with potential dehydration secondary to vomiting. Differences exist regarding culprit foods, onset symptoms, and age of tolerance depending on the country of origin. We aimed to describe the characteristics of a French population of children with FPIES. Methods Data from 179 children who were referred for acute or chronic FPIES in two pediatric tertiary centers between 2014 and 2020 were retrospectively collected. The diagnosis of FPIES was based on international consensus guidelines. Clinical characteristics, culprit food and age at resolution were assessed. Results In the 192 described FPIES, the age at first symptoms was 5.8 months old. The main offending foods were cow’s milk (60.3%), hen’s egg (16.2%), and fish (11.7%). Single FPIES was observed in 94.4% and multiple FPIES in 5.6% of cases. The age at resolution of FPIES was 2.2 years old, and resolution occurred later for fish than for milk (2.9 years versus 2.0, p=0.01). Severe acute FPIES was a risk factor for delayed resolution (relative risk: 3.3 [1.2-9.2]), but not IgE sensitization. Performing an oral food challenge within 12 months after the first reaction increased the risk of failure (RR: 2.0 [1.2-3.5]). Conclusion In this French cohort of children with FPIES, the main culprit foods were ubiquitous. Rice, oat and soy were rarely or not involved. Multiple FPIES was infrequent. Our data confirmed the overall good prognosis of FPIES, the later resolution of FPIES to fish and in the case of severe acute FPIES.

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“…From a geographically diverse population of 441 children with FPIES, data provided by caregivers in the International FPIES Association showed that fish was the third lowest in the hierarchy of offending foods [ 58 ]. In contrast, reports from Mediterranean countries, specifically Greece [ 8 , 9 , 10 ], Italy [ 2 , 3 ], Spain [ 1 , 4 , 5 , 6 , 7 , 16 , 59 ], and Turkey [ 60 ] revealed fish as the first or second most commonly implicated food and a major trigger of solid food protein allergy. It has also been concluded that the resolution of fish-FPIES comes later than that from other foods [ 61 ], and many children with fish-FPIES will not overcome the disease during childhood [ 62 ].…”

Section: Food Protein-induced Enterocolitis Syndrome (Fpies) Caused By Fishmentioning

confidence: 99%

Alternative Fish Species for Nutritional Management of Children with Fish-FPIES—A Clinical Approach

et al. 2021

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In the Mediterranean region, fish is a common cause of food protein-induced enterocolitis syndrome (FPIES) in children. No laboratory tests specific to FPIES are available, and oral food challenge (OFC) is the gold standard for its diagnosis and testing for achievement of tolerance. Children with FPIES to fish are usually advised to avoid all fish, regardless of the species. Fish are typically classified into bony and cartilaginous, which are phylogenetically distant species and therefore contain less cross-reacting allergens. The protein β-parvalbumin, considered a pan-allergenic, is found in bony fish, while the non-allergenic α-parvalbumin is commonly found in cartilaginous fish. Based on this difference, as a first step in the therapeutic process of children with FPIES caused by a certain fish in the bony fish category (i.e., hake, cod, perch, sardine, gilthead sea bream, red mullet, sole, megrim, sea bass, anchovy, tuna, swordfish, trout, etc.), an OFC to an alternative from the category of cartilaginous fish is suggested (i.e., blue shark, tope shark, dogfish, monkfish, skate, and ray) and vice versa. Regarding the increased mercury content in some sharks and other large species, the maximum limit imposed by the European Food Safety Authority (EFSA) for weekly mercury intake must be considered. An algorithm for the management of fish-FPIES, including alternative fish species, is proposed.

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Phenotypes and natural history of food protein‐induced enterocolitis syndrome in the east Mediterranean region

Cited by 14 publications

References 24 publications

Food protein‐induced enterocolitis syndrome: A large French multicentric experience

Food protein‐induced enterocolitis syndrome: A large French multicentric experience

Food protein-induced enterocolitis syndrome: a large French multicentric experience

Alternative Fish Species for Nutritional Management of Children with Fish-FPIES—A Clinical Approach

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