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Kuang R, Levinthal DJ, Ghaffari AA, Del Aguila de Rivers CR, Tansel A, Binion DG. Nightshade Vegetables: A Dietary Trigger for Worsening Inflammatory Bowel Disease and Irritable Bowel Syndrome? Dig Dis Sci 2023:10.1007/s10620-023-07955-9. [PMID: 37202602 DOI: 10.1007/s10620-023-07955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
The Solanaceae family of plants, commonly known as Nightshade vegetables or Nightshades, contains a diverse range of crops of over 2000 members with significant culinary, economic, and cultural importance. Familiar edible Nightshades include tomatoes, peppers, eggplants, and white potatoes. Many pharmacologically active compounds used in traditional medicine, including atropine and hyoscyamine, are derived from Nightshades. In addition to these beneficial pharmacologic agents, Nightshade-derived glycoalkaloid compounds, a key defense mechanism against predation, have been shown to disrupt intestinal epithelium and to potentially activate mast cells in the gut mucosa, leading to adverse symptoms in humans. There is a new appreciation that mast cell activation is an allergic inflammatory mechanism contributing both to pain in irritable bowel syndrome (IBS) and to gut inflammation in inflammatory bowel disease (IBD). Given their ubiquity in Western diets and their shared glycoalkaloid active compounds, edible Nightshades are attracting new interest as a potential trigger for worsening gut symptoms in functional and inflammatory gastrointestinal disorders. Here, we review the limited existing literature on the adverse effects of Nightshade consumption, including the effects of Nightshade-derived glycoalkaloids on IBD gut inflammation, and the under-recognized contribution of Nightshades to food allergies and allergic cross-reactivity. We then highlight new evidence on the contributions of mast cell activation to GI disorder pathogenesis, including potential linkages between Nightshade antigens, intestinal mast cells, and GI dysfunction in IBS and IBD.
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Affiliation(s)
- Rebecca Kuang
- UPMC Department of Internal Medicine, Pittsburgh, PA, USA
| | - David J Levinthal
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amir A Ghaffari
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Claudia Ramos Del Aguila de Rivers
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Aylin Tansel
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Prevalence of sensitization and allergy to potato in a large population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:507-509. [DOI: 10.1016/j.jaip.2016.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/04/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022]
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Feuille E, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy. Curr Allergy Asthma Rep 2015; 15:50. [PMID: 26174434 DOI: 10.1007/s11882-015-0546-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Food protein-induced enterocolitis (FPIES), allergic proctocolitis (FPIAP), and enteropathy (FPE) are among a number of immune-mediated reactions to food that are thought to occur primarily via non-IgE-mediated pathways. All three are typically present in infancy and are triggered most commonly by cow's milk protein. The usual presenting features are vomiting with lethargy and dehydration in FPIES; bloody and mucous stools in FPIAP; and diarrhea with malabsorption and failure to thrive in FPE. Diagnosis is based on convincing history and resolution of symptoms with food avoidance; confirmatory diagnostic testing other than food challenge is lacking. The mainstay of management is avoidance of the suspected inciting food, with interval challenge to assess for resolution, which usually occurs in the first years of life. Studies published in the past few years clarify common presenting features, report additional culprit foods, address potential biomarkers, and suggest new management strategies.
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Affiliation(s)
- Elizabeth Feuille
- Jaffe Food Allergy Institute, Division of Pediatric Allergy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Food protein-induced enterocolitis syndrome (FPIES) is a poorly understood non-IgE-mediated food hypersensitivity, primarily affecting infants and toddlers. There are few data regarding pathophysiology of FPIES that suggest local intestinal imbalance between TNF-α and TGF-β. Patients frequently present with multiple reactions, which are characterized by projectile, repetitive emesis, dehydration, lethargy, and failure to thrive. Despite the severity of presentation, the diagnosis is frequently delayed, and patients often undergo extensive and invasive evaluation prior to reaching the diagnosis. RECENT FINDINGS Reviews published in the last year provide a general approach to diagnosis and management of FPIES and aim to increase awareness and understanding of FPIES among general pediatricians. SUMMARY Multicenter studies are necessary to reevaluate and modify the oral food challenge criteria. Research on the pathophysiology of FPIES reactions is necessary to provide insight into the evidence-based approach to diagnosis and management of FPIES. Registries are needed to understand the phenotype, triggers, and prevalence of FPIES.
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Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, Nowak-Węgrzyn A. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol 2014; 134:382-9. [PMID: 24880634 DOI: 10.1016/j.jaci.2014.04.008] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. FPIES diagnosis is frequently delayed because of the absence of classic allergic symptoms and lack of biomarkers. OBJECTIVE We sought to characterize the clinical features and resolution of FPIES in patients evaluated in our practice. METHODS Subjects 6 months to 45 years of age with FPIES were prospectively recruited for oral food challenges (OFCs). Medical records were searched to identify the subjects who did not participate in OFCs. RESULTS Among 160 subjects, 54% were male; median age at diagnosis was 15 months. We performed 180 OFCs to 15 foods in 82 subjects; 30% of the study population had FPIES confirmed based on OFC results. The most common foods were cow's milk (44%), soy (41%), rice (22.5%), and oat (16%). The majority (65%) reacted to 1 food, 26% reacted to 2 foods, and 9% reacted to 3 or more foods. The majority were atopic, and 39% had IgE sensitization to another food. Thirty-nine (24%) subjects had positive specific IgE levels to the food inducing FPIES. Among children with specific IgE to cow's milk, 41% changed from a milk FPIES to an IgE-mediated phenotype over time. The median age when tolerance was established was 4.7 years for rice, 4 years for oat, and 6.7 years for soy. Median age when milk tolerance was established for subjects with undetectable milk-specific IgE levels was 5.1 years, whereas none of the subjects with detectable milk-specific IgE became tolerant to milk during the study (P = .003). CONCLUSION FPIES typically resolves by age 5 years. Milk FPIES, especially with detectable food-specific IgE, can have a protracted course and eventually transition to acute reactions.
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Affiliation(s)
- Jean Christoph Caubet
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pediatric Allergy, University Hospital of Geneva, Geneva, Switzerland
| | - Lara Simone Ford
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Pediatrics & Child Health, Children's Hospital, Westmead, Australia
| | - Laura Sickles
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Jefferson Medical College, Philadelphia, Pa
| | - Kirsi M Järvinen
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Allergy and Immunology & Center for Immunology and Microbial Diseases, Albany Medical College, Albany, NY
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hugh A Sampson
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
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Saliakellis E, Borrelli O, Thapar N. Paediatric GI emergencies. Best Pract Res Clin Gastroenterol 2013; 27:799-817. [PMID: 24160935 DOI: 10.1016/j.bpg.2013.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/21/2013] [Indexed: 01/31/2023]
Abstract
Paediatric GI emergencies constitute a wide range of gut pathologies ranging from those that are common, easily diagnosed and treated to conditions that are rarer, often more severe and challenging to manage. Among a myriad of ordinary clinical symptoms and signs physicians have to identify the child with a serious, life-threatening pathology and initiate the appropriate diagnostic and therapeutic pathway. The aim of the review is to present and discuss a selection of key paediatric GI emergencies that provide challenges in diagnosis and treatment. These conditions are classified by their presentation or pathogenesis and include inflammatory conditions, those presenting with GI obstruction or haemorrhage and the ingestion of foreign bodies or caustic substances. The most recent advances regarding the management of these entities are discussed along with key areas of clinical practice and future research.
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Affiliation(s)
- Efstratios Saliakellis
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Karagol IHE, Yilmaz O, Egritas O, Topal E, Dalgic B, Bakirtas A. A Case of Food Protein-Induced Enterocolitis Triggered by Wheat. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:161-163. [PMID: 35923030 DOI: 10.1089/ped.2012.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized and frequently misdiagnosed non-IgE-mediated gastrointestinal food hypersensitivity disorder. We describe the first case of FPIES only to wheat confirmed by an oral food challenge (OFC). The male patient, who was breast fed for the first 2 months, and then was feeding with cow's milk-based formula until he became 4.5 months old, was given a tarhana soup (wheat and yoghurt) for the initial food trial. Two hours later, he started retching and vomited consecutively, suffering from watery diarrhea. He was taken to a medical center, where he was diagnosed acute gastroenteritis. He suffered from three more episodes after feeding wheat-containing foods. When the patient was 12 months old, an OFC with wheat was performed. Two hours after he had been challenged, he vomited repetitively, became lethargic, his systolic blood pressure dropped from 95 to 80 mm Hg and stool examination revealed eosinophils and leukocytes, which were negative before the challenge. The serum eosinophil count decreased from 460 to 270 μL and the neutrophil count increased from 2,200 to 10,500 μL at 6 h. The skin prick test with wheat extract, prick to prick test with whole wheat and serum-specific Ig E for wheat were negative. We conclude that FPIES can emerge with food in connection with eating habits or culture. In view of its potentially serious clinical course, it is critical to consider this diagnosis in young children presenting with acute onset of gastrointestinal symptoms or shock.
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Affiliation(s)
| | - Ozlem Yilmaz
- Department of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Odul Egritas
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Buket Dalgic
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Arzu Bakirtas
- Department of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey
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Järvinen KM, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome (FPIES): Current Management Strategies and Review of the Literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:317-22. [DOI: 10.1016/j.jaip.2013.04.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 11/25/2022]
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Leonard SA, Nowak-Wegrzyn A. Manifestations, diagnosis, and management of food protein-induced enterocolitis syndrome. Pediatr Ann 2013; 42:135-40. [PMID: 23805961 DOI: 10.3928/00904481-20130619-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CME EDUCATIONAL OBJECTIVES 1. Recognize manifestations, diagnosis, and management of food protein-induced enterocolitis syndrome (FPIES) in an outpatient setting. 2. Assess nutritional needs and provide anticipatory guidance for dietary management. 3. Recognize the indications of when to refer for assessment of resolution of FPIES using physician-supervised food challenges. Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized non-immunoglobulin E (IgE)-mediated gastrointestinal food allergy affecting primarily infants and toddlers. An abnormal response to food antigen resulting in local inflammation is thought to lead to increased intestinal permeability and fluid shift. The primary features of acute FPIES are repetitive, projectile vomiting, lethargy, pallor, diarrhea, and dehydration. Chronic FPIES is typically seen in young infants with continued exposure to cow's milk or soy-based formula. Biomarkers are lacking and patients may undergo extensive workups for their symptoms, which often leads to a delay in diagnosis and puts infants at risk for feeding difficulties, nutritional deficiencies, and failure to thrive. This review will provide a guide in how to recognize the clinical features of and manage FPIES.
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Affiliation(s)
- Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, Rady Children’s Hospital, San Diego, CA 92123, USA.
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Current world literature. Curr Opin Pediatr 2012; 24:770-9. [PMID: 23146873 DOI: 10.1097/mop.0b013e32835af8de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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