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Food Protein-Induced Enterocolitis Syndrome

Pernille Henriksen, Malene Landbo Børresen, Kathrin Dahl
Food protein-induced enterocolitis syndrome (FPIES) is a rare non-IgE mediated condition. Symptoms of acute FPIES include vomiting, diarrhoea and dehydration. Symptoms are often misread as acute abdomen or sepsis. The condition can be fatal. There are no biomarkers for FPIES, and skin prick test for cow milk is often negative. Treatment is hydrolysed formula milk. This case story describes a one-month-old boy with diarrhoea and an output of up till 2.3 l per day. With this case story we wish to increase the knowledge of FPIES and emphasize the importance of having the diagnosis in mind when confronted with the very ill, dehydrated infant...
October 10, 2016: Ugeskrift for Laeger
Judith Barasche, Fabiola Stollar, Marcel M Bergmann, Jean-Christoph Caubet
In infants, the causes of acute repetitive vomiting and severely altered-consciousness status include a broad differential diagnosis, that is, primarly sepsis, infectious gastroenteritis, head injury, and intoxication, as well as neurologic, metabolic, and cardiologic condition diseases. In patients developing such symptoms, allergy as an etiological cause is often not considered by primary care physicians. With this case report, we aim to draw the attention of general pediatricians, emergency physicians, and intensivists to the fact that non-immunoglobulin E-mediated food allergic gastrointestinal disorders such as food protein-induced enterocolitis syndrome should be considered in patients with sepsis-like symptoms...
October 6, 2016: Pediatric Emergency Care
Étienne Bidat, Grégoire Benoist
A little known pathology, increasingly diagnosed. Late vomiting after food intake predominate. An insidious chronic form, an explosive acute form. A clinical diagnosis of a typical story, reproducible. Milk and soy often involved, sometimes unusual foods.
October 3, 2016: La Presse Médicale
Celia Zubrinich, Mark Hew, Robyn O'Hehir
Food protein-induced enterocolitis syndrome is a non-IgE-mediated food allergy usually diagnosed in infancy. We report a case of a similar syndrome in an adult, following ingestion of egg. We remind clinicians to consider this diagnosis which may present to emergency physicians and gastroenterologists long before an allergist is consulted.
September 2016: Clinical Case Reports
Jean-Christoph Caubet, Hania Szajewska, Raanan Shamir, Anna Nowak-Węgrzyn
Non-IgE-mediated gastrointestinal food allergic disorders (non-IgE-GI-FA) including food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE) and food protein-induced allergic proctocolitis (FPIAP) are relatively uncommon in infants and young children, but are likely under-diagnosed. Non-IgE-GI-FA have a favorable prognosis, with majority resolving by age 3-5 years. Diagnosis relies on the recognition of symptoms pattern in FPIAP and FPIES and biopsy in FPE. Further studies are needed for a better understanding of the pathomechanism, which will lead eventually to the development of diagnostic tests and treatments...
September 17, 2016: Pediatric Allergy and Immunology
Mitsuaki Kimura, Masaki Shimomura, Hideaki Morishita, Takaaki Meguro, Shiro Seto
BACKGROUND: Many Japanese infants with food protein-induced enterocolitis syndrome (FPIES) show eosinophilia, which has been thought to be a characteristic of food protein-induced proctocolitis (FPIP). METHODS: To elucidate the characteristics of eosinophilia in Japanese FPIES patients, 113 infants with non-IgE-mediated gastrointestinal food allergy due to cow's milk were enrolled and classified into FPIES (n = 94) and FPIP (n = 19). RESULTS: The percentage of peripheral blood eosinophils (Eo) was increased in most FPIES patients (median, 7...
September 10, 2016: Allergology International: Official Journal of the Japanese Society of Allergology
Tamar Weinberger, Elizabeth Feuille, Cecilia Thompson, Anna Nowak-Węgrzyn
No abstract text is available yet for this article.
September 2016: Annals of Allergy, Asthma & Immunology
Taizo Wada, Yusuke Matsuda, Tomoko Toma, Eiko Koizumi, Hiroyuki Okamoto, Akihiro Yachie
BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is an uncommon, non-IgE-mediated food allergy. We recently described a significant increase in fecal eosinophil-derived neurotoxin (EDN) after ingestion of the causative food. However, little is known about the activation status of circulating eosinophils in patients with an acute FPIES reaction. METHODS: Surface CD69 expression was assessed by flow cytometry on peripheral eosinophils from 5 patients with FPIES before and after ingestion of the causative food...
2016: International Archives of Allergy and Immunology
Hazel A Smith, Genevieve E Becker
BACKGROUND: Health organisations recommend exclusive breastfeeding for six months. However, the addition of other fluids or foods before six months is common in many countries. Recently, research has suggested that introducing solid food at around four months of age while the baby continues to breastfeed is more protective against developing food allergies compared to exclusive breastfeeding for six months. Other studies have shown that the risks associated with non-exclusive breastfeeding are dependent on the type of additional food or fluid given...
2016: Cochrane Database of Systematic Reviews
Stefano Miceli Sopo, Giulia Bersani, Serena Monaco, Giuseppe Cerchiara, Eric Lee, Dianne Campbell, Sam Mehr
BACKGROUND: Therapy for moderate to severe acute food protein induced enterocolitis syndrome (FPIES) typically consists of intravenous fluids and corticosteroids (traditional therapy). Ondansetron has been suggested as an adjunctive treatment. We aimed to evaluate the efficacy of the parenteral (intravenous or intramuscular) ondansetron vs. traditional therapy to resolve symptoms of acute FPIES. METHODS: Cases of FPIES who had a positive oral food challenge (OFC) were retrospectively examined at two major hospitals over a 2 year period (Rome, Italy and Sydney, Australia)...
August 22, 2016: Allergy
Jean Christoph Caubet, Ramon Bencharitiwong, Andrew Ross, Hugh A Sampson, M Cecilia Berin, Anna Nowak-Węgrzyn
BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy manifesting within 1 to 4 hours of food ingestion with repetitive emesis and lethargy. OBJECTIVE: We sought to characterize immune responses to casein in children with FPIES caused by cow's milk (CM). METHODS: Total IgE and IgM, CM-specific IgG, and casein-specific IgE, IgG, IgG4, and IgM levels, as well as immunoglobulin free light chains, were measured in both patients with active and those with resolved CM-FPIES...
July 15, 2016: Journal of Allergy and Clinical Immunology
P Comberiati, M Landi, A Martelli, G L Piacentini, C Capristo, G Paiola, D G Peroni
BACKGROUND: Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPIES), is an increasingly reported and potentially severe non-IgE mediated food allergy of the first years of life, which is often misdiagnosed due to its non-specific presenting symptoms and lack of diagnostic guidelines. OBJECTIVE: We sought to determine the knowledge of clinical, diagnostic and therapeutic features of FPIES among Italian primary-care paediatricians...
September 2016: Allergologia et Immunopathologia
Mitsuaki Kimura, Masaki Shimomura, Hideaki Morishita, Takaaki Meguro, Shiro Seto
BACKGROUND: Some infants with food protein-induced enterocolitis syndrome (FPIES) have increased serum C-reactive protein (CRP) and fever in Japan. The aim of this study was therefore to clarify and compare the incidence of this in patients with FPIES versus patients with food protein-induced proctocolitis (FPIP). METHODS: One hundred and sixteen infants with non-IgE-mediated gastrointestinal food allergies were enrolled in this study and classified into three phenotypes: FPIES presenting with vomiting and/or diarrhea (n = 47); FPIP with bloody stool alone (n =19); and the mixed phenotype (MP), bloody stool with vomiting and/or diarrhea (n = 50)...
September 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Neha Khanna, Kirtika Patel
Purpose of Review. The aim of this review is to provide a case driven presentation of the presenting features and diagnostic criteria particularly focusing on the management of FPIES. It also summarises the natural history and resolution of cow's milk induced FPIES. Data Sources. OvidSP Database was used to search for literature using the keywords food protein-induced enterocolitis and FPIES. Recent Findings. The diagnosis of FPIES is often delayed following two or more presentations. Symptoms in the acute form include profuse vomiting usually 2-6 hours following ingestion of food...
2016: Case Reports in Pediatrics
Mitsuaki Kimura, Yasunori Ito, Fumika Tokunaga, Takaaki Meguro, Masaki Shimomura, Hideaki Morishita, Shiro Seto
BACKGROUND: Increased C-reactive protein (CRP) and fever are observed in some infants with food protein-induced enterocolitis syndrome (FPIES) in Japan, but the reproducibility of these findings has not yet been confirmed on oral food challenge (OFC). METHODS: Fourteen infants with FPIES induced by cow's milk (CM) formula were enrolled. OFC using CM formula was performed on each infant once or repeatedly (total 18 tests), with a stepwise incremental protocol in an infection-controlled setting...
September 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Rhonda Mattingly, Vincent Mukkada, Alan Smith, Teresa Pitts
This case study examines the difficulties of treating food aversion in a 9-month old child with a diagnosis of Food Protein-Induced Enterocolitis Syndrome (FPIES). Given the need to first identify a set of "safe foods" with which to work, the twin goals of doing food challenges and minimizing aversion are initially not complimentary, and require an approach outside the standard of care. The chosen plan encouraged flexibility and a positive relationship with feeding-related items, while only introducing one food item at a time...
August 2015: Journal of Pulmonary & Respiratory Medicine
Matthew Greenhawt, Fallon Schultz, Audrey DunnGalvin
No abstract text is available yet for this article.
April 2016: Journal of Allergy and Clinical Immunology
Purificación González-Delgado, Esther Caparrós, M Victoria Moreno, Fernando Clemente, Emilio Flores, Laura Velásquez, Gonzalo Rubio, Javier Fernández
BACKGROUND: Food protein-induced enterocolitis (FPIES) is an uncommon, non-IgE-mediated food allergy that usually debuts in infancy with profuse vomiting, lethargy, and pallor 2-4 h following ingestion of the offending food. Its immune mechanism is not known. We aimed to describe the clinical features and outcome of children with fish-FPIES as well as to investigate on cellular immune response implicated. METHODS: Prospective and follow-up clinical study of children with FPIES by fish over a period between 2004 and 2013 was conducted...
May 2016: Pediatric Allergy and Immunology
Stephanie A Leonard, Anna Nowak-Węgrzyn
Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-immunoglobulin E-mediated gastrointestinal food allergy primarily diagnosed in infancy, but has also been reported in older children and adults. Acute FPIES reactions typically present with delayed, repetitive vomiting, lethargy, and pallor within 1 to 4 hours of food ingestion. Chronic FPIES typically presents with protracted vomiting and/or diarrhea, and weight loss or poor growth. Common foods triggering FPIES include cow's milk, soy, rice, oats, fish, and egg...
December 2015: Pediatric Clinics of North America
Stefano Miceli Sopo, Serena Monaco, Laura Badina, Simona Barni, Giorgio Longo, Elio Novembre, Serena Viola, Giovanna Monti
BACKGROUND: The study describes the demographic features, culprit foods, clinical features and outcomes for children presenting with acute fish and/or shellfish food protein-induced enterocolitis syndrome (FPIES) in four Italian paediatric allergy centres. METHODS: A retrospective/prospective study was undertaken. All children diagnosed with fish or shellfish FPIES were enrolled. The diagnosis of FPIES was based on Sicherer's or Miceli Sopo clinical criteria. Skin prick tests (SPT) were performed in all patients, at the time of diagnosis and prior to OFC...
December 2015: Pediatric Allergy and Immunology
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