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Akashi M, Kaburagi S, Kajita N, Morita H. Heterogeneity of food protein-induced enterocolitis syndrome (FPIES). Allergol Int 2024; 73:196-205. [PMID: 38553113 DOI: 10.1016/j.alit.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy with gastrointestinal symptoms such as vomiting and diarrhea. The development of international consensus guidelines for the diagnosis and management of FPIES in 2017 enabled us to compare patients worldwide, regardless of geographic variation in disease features. As a result, it has become clear that there is heterogeneity among patients with FPIES or that there are cases that partly fit the diagnostic criteria for FPIES but have different characteristics. This review highlights the heterogeneity in FPIES characteristics in terms of trigger foods, the age of onset, differences in geographic regions, and symptoms; it further proposes four disease entities, including acute FPIES in children, acute FPIES in adults, chronic FPIES, and early-onset neonatal FPIES, depending on the age of onset and presumed pathophysiology. The major symptoms at onset and trigger foods differ in acute FPIES in children, acute FPIES in adults, and chronic FPIES, whereas the disease entities may share a similar pathophysiology. Early-onset neonatal FPIES may have a different pathophysiology than acute or chronic FPIES, and may not necessarily fulfil the full diagnostic criteria for acute or chronic FPIES described in the international consensus guidelines. Due to the similarity in symptoms, early-onset neonatal FPIES may sometimes be misdiagnosed as necrotizing enterocolitis. We aim to increase awareness of FPIES among medical staff in pediatrics, neonatology, and internal medicine and promote research, to gain a better understanding of the heterogeneity and pathophysiology of FPIES.
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Affiliation(s)
- Masayuki Akashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Sachiko Kaburagi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Kajita
- Department of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Allergy Center, National Center for Child Health and Development, Tokyo, Japan.
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Miceli Sopo S, Mastellone F, Bersani G, Gelsomino M. Personalization of Complementary Feeding in Children With Acute Food Protein-Induced Enterocolitis Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:620-623. [PMID: 37778631 DOI: 10.1016/j.jaip.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a food allergy that results in repetitive vomiting, lethargy, and pallor within 1 to 4 hours of food ingestion. One of the issues in its management is the introduction of new foods. Over the past 25 years, suggestions have been made mainly based on the likelihood that a given food family could induce an episode of acute FPIES. Thus, foods have been categorized into low, moderate, and high risk. The suggestion was always to postpone the introduction of moderate- or high-risk foods, leaving the decision whether to introduce them at home or in hospital to the doctor. These suggestions were designed for all children with acute FPIES, regardless of their geographical area. However, it is true that these suggestions are the result of expert opinion. In recent years, studies have been published that have shown that the risk category of foods varies according to geographical area and so does the prevalence of single FPIES versus multiple FPIES. For this reason, we believe that the introduction of new foods in the child with acute FPIES can and should be tailored according to the geographical area.
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Affiliation(s)
- Stefano Miceli Sopo
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, Pediatrics Section, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy.
| | - Francesco Mastellone
- Department of Life Sciences and Public Health, Post-Graduate School of Pediatrics, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Giulia Bersani
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, Pediatrics Section, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Mariannita Gelsomino
- Department of Life Sciences and Public Health, Post-Graduate School of Pediatrics, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
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McIntyre A, Caulum A, Cox A, Sanchez D, Sampson H, Baker MG, Singh AM. Food protein-induced enterocolitis syndrome (FPIES) after multiple tolerant ingestions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:324-325. [PMID: 35868451 PMCID: PMC10601406 DOI: 10.1016/j.jaip.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Amanda McIntyre
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wis
| | - Amy Caulum
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin- Madison, Madison, Wis
| | - Amanda Cox
- Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, Department of Pediatrics, Division of Allergy & Immunology, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY
| | - David Sanchez
- Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, Department of Pediatrics, Division of Allergy & Immunology, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY
| | - Hugh Sampson
- Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, Department of Pediatrics, Division of Allergy & Immunology, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY
| | - Mary Grace Baker
- Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, Department of Pediatrics, Division of Allergy & Immunology, The Elliot and Roslyn Jaffe Food Allergy Institute, New York, NY
| | - Anne Marie Singh
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis; Department of Dermatology, University of Wisconsin-Madison, Madison, Wis; Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wis.
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Jacobs S, Trogen B, Nowak-Wegrzyn A. Recurrence of Food Protein-Induced Enterocolitis Syndrome (FPIES) Following a Food Challenge. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:326-328. [PMID: 36610758 DOI: 10.1016/j.jaip.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Samantha Jacobs
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Brit Trogen
- Allergy and Immunology, Department of Medicine, Icahn School of Medicine, New York, NY
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
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Crespo J, Pérez-Pallise ME, Skrabski F, Zambrano G, Rojas-Pérez-Ezquerra P, Noguerado-Mellado B, Zubeldia JM, Infante S. The Natural Course of Adult-Onset Food Protein-Induced Enterocolitis Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2986-2992. [PMID: 35753669 DOI: 10.1016/j.jaip.2022.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adult-onset food protein-induced enterocolitis syndrome (FPIES) has been increasingly recognized in recent years. Adult FPIES differs from pediatric FPIES in terms of dietary triggers and symptoms, thus further broadening the clinical phenotypes of the disease. The natural history of FPIES in adulthood is poorly characterized. OBJECTIVE To evaluate the natural course of FPIES in adults. METHODS We performed an ambispective study of adults diagnosed with acute FPIES during 2016-2021. Data on age, sex, symptoms, implicated food, and oral food challenge (OFC) outcomes at baseline and during follow-up were analyzed. RESULTS Forty-two adults were included (83.3% female; median age at diagnosis, 40 years). The predominant symptoms were diarrhea (92.9%) and abdominal cramps (71.4%); vomiting was reported by 59% of patients. The most common triggers were shellfish (n = 19, 45.2%) and fish (n = 19, 45.2%). The mean number of reactions before diagnosis was 6.3 (2-15). Twenty-one OFCs were carried out with the offending food in 15 patients. Six patients achieved tolerance (40%) after a mean of 17.8 months (range, 6-36 months). Twelve of all OFCs performed were positive (57.1%). The absolute leukocyte and neutrophil counts measured before and 1 to 2 hours after the positive challenge showed a mean increase of 3045 and 2736 cells/μL, respectively. Serum tryptase, C-reactive protein, and eosinophil and platelet values did not change significantly after the OFC. CONCLUSION Some patients may outgrow adult-onset FPIES.
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Affiliation(s)
- Jimena Crespo
- Allergy Department, Clínica Universidad de Navarra, Madrid, Spain; Universidad de Alcalá, Madrid, Spain
| | - María Esperanza Pérez-Pallise
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain
| | - Filip Skrabski
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain
| | - Gabriela Zambrano
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain
| | - Patricia Rojas-Pérez-Ezquerra
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain
| | - Blanca Noguerado-Mellado
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain
| | - José Manuel Zubeldia
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain
| | - Sonsoles Infante
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Gregorio Marañón Health Research Institute (IiGSM), Madrid, Spain.
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Feketea G, Vassilopoulou E, Geropanta F, Berghea EC, Bocsan IC. Alternative Fish Species for Nutritional Management of Children with Fish-FPIES—A Clinical Approach. Nutrients 2021; 14:nu14010019. [PMID: 35010894 PMCID: PMC8746553 DOI: 10.3390/nu14010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/25/2022] Open
Abstract
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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Affiliation(s)
- Gavriela Feketea
- PhD School, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
- Department of Pediatrics, Amaliada Hospital, 27200 Amaliada, Greece
- Department of Pediatrics, Karamandaneio Children’s Hospital, 26331 Patras, Greece
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece;
| | | | - Elena Camelia Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatrics, “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
- Correspondence:
| | - Ioana Corina Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
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Argiz L, Infante S, Machinena A, Pascal M, Echeverria L, Barni S, Garriga-Baraut T, Arasi S, Moure JD, Gomez-Carballa A, Martinon-Torres F, Boyle RJ, Vazquez-Ortiz M. Reactions on re-exposure following negative and inconclusive follow-up food challenges in children with acute FPIES. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3228-3231.e3. [DOI: 10.1016/j.jaip.2020.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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Barni S, Liotti L, Mori F, Liccioli G, Pucci N, Novembre E. Are oral food challenges for introduction of high-risk foods in children with food protein-induced enterocolitis syndrome needed? Pediatr Allergy Immunol 2020; 31:326-329. [PMID: 31765506 DOI: 10.1111/pai.13180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Lucia Liotti
- Pediatric Unit, Hospital of Senigallia, Senigallia, Italy
| | | | | | - Neri Pucci
- Meyer Children's Hospital, Florence, Italy
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