Abstract
Non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) is the name given to a series of pathologies whose main entities are food protein-induced allergic proctocolitis (FPIAP), food protein-induced enteropathy (FPE), and food protein-induced enterocolitis syndrome (FPIES). These are more uncommon than IgE-mediated food allergies, their mechanisms remain largely unknown, and their diagnosis is mainly done by clinical history, due to the lack of specific biomarkers. In this review, we present the latest advances found in the literature about clinical aspects, the current diagnosis, and treatment options of non-IgE-GI-FAs. We discuss the use of animal models, the analysis of gut microbiota, omics techniques, and fecal proteins with a focus on understanding the pathophysiological mechanisms of these pathologies and obtaining possible diagnostic and/or prognostic biomarkers. Finally, we discuss the unmet needs that researchers should tackle to advance in the knowledge of these barely explored pathologies.
Highlights
Academic Editors: Sara Benedé and Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular
Other studies have reported that food protein-induced allergic proctocolitis (FPIAP) represents between 18% and 64% of children with rectal bleeding when the diagnosis is based on withdrawal of the offending food or by biopsy findings from the flexible sigmoidoscopy [10,11]
All patients with food protein-induced enterocolitis syndrome (FPIES) should undergo an oral food challenge (OFC) at least and soy-induced FPIES are reported to occur at an earlier age than other foods
Summary
Food allergy (FA) is a specific immunological response that occurs reproducibly on exposure to a given food. FPIES is considered a non-IgE-mediated FA, in some patients, it is possible to detect specific IgE against the causal food, either at the beginning or during the course of the disease This form of presentation is known as atypical FPIES and it seems to have a protracted course, with a further risk of developing IgE-mediated symptoms. There is not a specific biomarker for FPIES that allows for confirmation of the diagnosis or to predict when the tolerance to the offending food has been achieved For this reason, all patients with FPIES should undergo an oral food challenge (OFC) at least and soy-induced FPIES are reported to occur at an earlier age than other foods.
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