Clinical features of mild and severe acute Food protein–induced enterocolitis (FPIES)

wp-1494994478845.Clinical features of mild and severe acute Food protein–induced enterocolitis (FPIES)

Food protein–induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available.

Clinical features of mild and severe acute FPIES

Clinical features of mild and severe acute FPIES
Mild-to-moderate acute FPIES Severe acute FPIES
Clinical features
    Required

  • Vomiting (onset usually 1-4 h, can range from 30 min to 6 h): few episodes of intermittent vomiting (1-3), can be bilious
  • Decreased activity level
  • Pallor
  • Self-resolving; the child is able to tolerate oral rehydration at home
    Optional

  • Mild watery diarrhea, onset usually within 24 hours, can be bloody (occasionally)
    Required

  • Vomiting (onset usually at 1-4 h, can range from 30 min to 6 h): projectile (forceful), repetitive (≥4), bilious and dry heaving
  • Altered behavior ranging from decreased activity to lethargy
  • Pallor
  • Dehydration
  • Requires intravenous hydration
    Optional

  • Hypotension
  • Abdominal distention
  • Hypothermia
  • Diarrhea, onset usually within 24 hours, can be bloody
  • Hospitalization
Laboratory features (optional, when available)
  • Increased white blood cell count with neutrophilia
  • Thrombocytosis
  • Stool might be positive for leukocytes, eosinophils, or increased carbohydrate content
  • Increased white blood cell count with neutrophilia
  • Thrombocytosis
  • Metabolic acidosis
  • Methemoglobinemia
  • Stool might be positive for leukocytes, eosinophils, or increased carbohydrate content

Chronic FPIES is less well characterized compared with acute FPIES and only reported in infants younger than 4 months of age fed with cow’s milk (CM) or soy infant formula. Chronic FPIES develops on regular/repeated ingestion of the triggering food, presenting as chronic/intermittent emesis, watery diarrhea, and failure to thrive  Severe chronic FPIES can lead to dehydration and shock. Hypoalbuminemia and poor weight gain can predict chronic CM-induced FPIES in young infants with chronic gastrointestinal symptoms. With elimination of the chronic FPIES food trigger or triggers, symptoms resolve, but subsequent feeding (accidental exposure or oral food challenge [OFC]) induces an acute FPIES reaction within 1 to 4 hours of food ingestion. The acute symptomatology after food avoidance distinguishes chronic FPIES from food protein–induced enteropathy, eosinophilic gastroenteritis, or celiac disease. Chronic FPIES is uncommon but appears to be diagnosed more frequently in Japan and Korea.

References

  • International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. http://www.jacionline.org/article/S0091-6749(17)30153-7/fulltext#cebib0010
  • Powell, G.K. Milk- and soy-induced enterocolitis of infancy. Clinical features and standardization of challenge. J Pediatr. 1978; 93: 553–560
  • Burks, A.W., Casteel, H.B., Fiedorek, S.C., Willaims, L.W., and Pumphrey, C.L. Prospective oral food challenge study of two soybean protein isolates in patients with possible milk or soy protein enterocolitis. Pediatr Allergy Immunol. 1994; 5: 40–45
  • Sicherer, S.H., Eigenmann, P.A., and Sampson, H.A. Clinical features of food-protein-induced entercolitis syndrome. J Pediatr. 1998; 133: 214–219
  • Mehr, S., Kakakios, A., Frith, K., and Kemp, A.S. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009; 123: e459–e464

wp-1494994478845.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s