Chronic Milk-Dependent Food Protein-Induced Enterocolitis Syndrome in Children from West Pomerania Region

Karolina Bulsa,Małgorzata Standowicz,Grażyna Czaja-Bulsa,Elżbieta Baryła-Pankiewicz

doi:10.3390/nu13114137

Karolina Bulsa, Małgorzata Standowicz + Show 2 more

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https://doi.org/10.3390/nu13114137

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Journal: Nutrients	Publication Date: Nov 19, 2021
Citations: 2	License type: CC BY 4.0

Affiliation: University of Szczecin, Pomeranian Medical University

Abstract

Characteristics of chronic milk-dependent food protein-induced enterocolitis syndrome (FPIES) in children from the region of Western Pomerania were studied. Prospectively, 55 children were diagnosed at a median of 2.2 months. The open food challenges (OFC), morphologies, milk-specific IgE (sIgE) (FEIA method, CAP system), and skin prick tests (SPTs) were examined. Vomiting and diarrhea escalated gradually but quickly led to growth retardation. Of the infants, 49% had BMI < 10 c, 20% BMI < 3 c; 25% had anemia, and 15% had hypoalbuminemia. During the OFCs we observed acute symptoms that appeared after 2–3 h: vomiting diarrhea and pallor. A total of 42% children required intravenous hydration. Casein hydrolysates or amino acids formulae (20%) were used in treatment. In 25% of children, SPT and milk sIgE were found, in 18%—other food SPTs, and in 14% allergy to other foods. A transition to IgE-dependent milk allergy was seen in 3 children. In the twelfth month of life, 62% of children had tolerance to milk, and in the twenty-fifth month—87%. Conclusions. Chronic milk-dependent FPIES resolves in most children. By the age of 2 children are at risk of multiple food sensitization, and those who have milk sIgE are at risk to transition to IgE-mediated milk allergy. Every OFC needs to be supervised due to possible severe reactions.

Highlights

Cow’s milk allergy (CMA) is the most common allergy in the first year of life
food protein-induced enterocolitis syndrome (FPIES) was diagnosed in these children, with a delayed response during open food challenges (OFC), in whom occurred vomiting, pallor, and diarrhea, and often severe dehydration
Symptoms of CMA appeared after cessation of breastfeeding and introduction of milk formula (80% of children) or mixed feeding (20% of children)

Summary

Introduction

Cow’s milk allergy (CMA) is the most common allergy in the first year of life. It takes two forms: the IgE-mediated CMA (IgE-CMA) and the non-IgE mediated CMA (non-IgE-CMA). In contrast to IgE-CMA, the diagnosis of various non-IgE-CMA syndromes can be challenging due to the overall lack of noninvasive confirmatory testing for these disorders. Many of the non-IgE-CMA syndromes are diagnosed clinically based on history, diagnostic milk-free diet, and followed by positive milk provocation test, which is a “gold standard” for diagnosing these diseases [1,2]. The first classification of non-IgE-CMA gastrointestinal disorders was proposed by Sampson HA in 2003 [3]. It covers three items: food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy syndrome (FPIE) as well as the syndrome of eosinophilic gastrointestinal diseases (EGID), where milk can cause allergic reactions under the IgE-dependent and IgE-independent mechanism

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