Food Protein-induced Enterocolitis Syndrome Reactions Research Articles

Evolution of Food Protein-Induced Enterocolitis Syndrome (FPIES) Index Trigger Foods and Subsequent Reactions After Initial Diagnosis.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy treated by trigger food avoidance and supportive care. Whether the prevalence of different trigger foods is changing with evolving food introduction patterns is unknown. The rate and nature of subsequent reactions after initial diagnosis have not been fully studied. We sought to characterize how trigger foods have changed over time and investigate the nature of subsequent reactions after initial diagnosis. We collected data regarding patients' FPIES reactions from 347 patients seen in the University of Michigan Allergy and Immunology clinic for FPIES from 2010 to 2022. Inclusion criteria consisted of pediatric patients diagnosed with FPIES by an allergist based on international consensus guidelines. Most foods including less commonly cited FPIES triggers increased in frequency over time. The most common index trigger was oat. A total of 32.9% (114 of 347) patients experienced a subsequent reaction after education on trigger avoidance and safe home introduction of new foods, with 34.2% (41 of 120) of subsequent reactions to new triggers at home and 45% (54 of 120) to known triggers at home. Of patients reacting subsequently, 28% (32 of 114) experienced a subsequent reaction necessitating an emergency department visit. The most common new subsequent reaction triggers were egg and potato, whereas peanut most commonly triggered reactions on oral food challenge. The risk profile of FPIES triggers may be evolving over time, though high-risk FPIES foods remain common. The subsequent reaction rate after counseling indicates that home food introduction poses risk. This study highlights the need for improved safety of new food introduction and/or prediction methods for FPIES to help prevent potentially dangerous home FPIES reactions.

Untargeted serum metabolomic analysis reveals a role for purinergic signaling in FPIES

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy with a typical onset in infancy. Its symptoms are distinct from those of IgE-mediated food allergies and include severe repetitive vomiting, lethargy, and pallor. FPIES reactions are associated with TH17 cytokines and a systemic innate immune activation; however, the link between immune activation and symptoms is poorly understood. Our aim was to use an untargeted metabolomics approach to identify novel pathways associated with FPIES reactions. Serum samples were obtained before, during, and after oral food challenge (OFC) (10 subjects with FPIES and 10 asymptomatic subjects), and they were analyzed by untargeted metabolomics. Two-way ANOVA with false discovery rate adjustment was used for analysis of metabolites. Stomach and duodenal biopsy specimens from non-FPIES donors were stimulated with adenosine invitro and serotonin measured by immunoassay. The levels of a total of 34 metabolites, including inosine and urate of the purine signaling pathway, were increased during OFCs performed on the patients with symptomatic FPIES compared with the levels found for asymptomatic subjects. Expression of the purine receptors P2RX7 and P2RY10 and the ectonucleotidase CD73 in peripheral blood was significantly reduced after OFC of the patients with FPIES. The level of the serotonin metabolite 5-hydroxyindoleacetate was significantly elevated after reaction. Adenosine stimulation of gastric and duodenal biopsy specimens from FPIES-free donors induced a significant release of serotonin, suggesting a link between purinergic pathway activation and serotonin release. Activation of the purinergic pathway during FPIES reactions provides a possible mechanism connecting inflammation and vomiting by triggering serotonin release from gastric and duodenal mucosa.

Innate immune activation occurs in acute food protein–induced enterocolitis syndrome reactions

Innate immune activation occurs in acute food protein–induced enterocolitis syndrome reactions

Food protein-induced enterocolitis syndrome: guidelines summary and practice recommendations.

Food protein-induced enterocolitis syndrome (FPIES) is a poorly understood non-IgE gastrointestinal-mediated food allergy that predominantly affects infants and young children. Cells of the innate immune system appear to be activated during an FPIES reaction. Acute FPIES typically presents between one and 4 hours after ingestion of the trigger food, with the principal symptom being profuse vomiting, and is often accompanied by pallor and lethargy. Additional features can include hypotension, hypothermia, diarrhoea, neutrophilia and thrombocytosis. In Australia, the most commonly reported foods responsible for FPIES are (in descending order) rice, cow's milk, egg, oats and chicken. Most children with FPIES react to only one food trigger, and thus, avoidance of multiple foods is often not indicated. FPIES is often misdiagnosed as sepsis or gastroenteritis. However, a diagnosis of FPIES is favoured if there is rapid resolution of symptoms within hours of presentation, an absence of fever, and a lack of a significant rise in C-reactive protein at presentation. Diagnosis is often hampered by the lack of awareness of FPIES, absence of reliable biomarkers, the non-specific nature of the presenting symptoms, and the delay between allergen exposure and symptoms. Although some national peak allergy bodies have attempted to improve the diagnosis and management of FPIES, up until 2017 there were no internationally agreed guidelines for its diagnosis and management.

NON-TRANSFERENCE OF FOOD ALLERGY AND FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) AFTER BONE MARROW TRANSPLANT

Introduction Transfer of food allergy after bone marrow and solid organ transplant are well described in literature. Here we report a case of non-transference of IgE mediated food allergy (peanut) and Food Protein-Induced Enterocolitis Syndrome (FPIES) (egg) following related donor bone marrow transplant. Case Description The donor is a 3 year-old female who initially presented with typical symptoms of egg related FPIES at 9 months of age. Subsequently was found to be sensitized to peanut (IgE 0.34 kUA/L). She initially passed peanut challenge, but peanut was never introduced. She lost tolerance and developed IgE mediated allergy to peanuts. Peanut allergy was confirmed upon challenge at 2 years of age. She has since avoided peanuts. She continues to have FPIES to egg. Her most recent FPIES reaction following accidental ingestion of egg and requiring fluid resuscitation was at 2 years of age. During this time, she served as a related bone marrow donor for her sibling. Even after withdrawal of the majority of immunosuppression and immune reconstitution with the donor bone marrow the sibling continues to tolerate both egg and peanut. Discussion Though transfer of food allergy has been reported following bone marrow transplant. This is the first case where transfer of FPIES has been a concern. This case is also unique because both FPIES and anaphylactic food allergy co-existed in the donor. Allergy in the donor was documented before and after transplant and likewise tolerance was documented in the recipient pre and post-transplant.

Inflammatory events during food protein-induced enterocolitis syndrome reactions.

An increasing number of infants are diagnosed with food protein-induced enterocolitis syndrome (FPIES), a non-IgE-mediated food allergy. Until now, T-cell, food-specific mechanisms have been hypothesized. Sixteen children (11M, 5F), affected by FPIES from cow's milk, wheat, fruit, rice, and others, experienced 25 acute episodes managed at our emergency department (ED) and eight FPIES reactions during oral food challenges (OFC). We compared the laboratory data in resting conditions, in the absence of infectious diseases, with data collected during the 25 acute ED episodes (blood samples drawn at 2-12hours) and the eight positive OFCs (three samples at 2, 6, and 12hours). The onset of symptoms was used as a reference time point. In basal conditions, total IgE, WBC, neutrophil and eosinophil count, CRP, and SGPT were found normal. LDH and SGOT values were high (627.81±97.88 and 45.75±10.26UI/L, respectively). During ED reactions, LDH and SGOT increased to 794.21±247.28 (P=.028) and 51.08±16.99UI/L (P=.14) and neutrophils count and CRP to 8.44±3.82×103 /μL (P=.0009) and 3.27±5.73mg/dL (P=.0014), respectively. During positive OFC, LDH and SGOT did not vary significantly; CRP increased from 0.14±0.18 to 2.49±3.65mg/dL (P=.00189) and neutrophil count from 2.79±1.42 to 7.10±3.98×103 /μL (P=.00096). FPIES reactions are characterized by neutrophilia and by a time-dependent, significant increase in CRP, indicating that inflammatory mechanisms are in place. This suggests new directions for research on FPIES pathogenesis.

Early additional food and fluids for healthy breastfed full-term infants.

Early additional food and fluids for healthy breastfed full-term infants.