Mary Grace Baker1, M Cecilia Berin2, Scott Sicherer2. 1. Icahn School of Medicine at Mount Sinai, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA. marygrace.baker@mssm.edu. 2. Icahn School of Medicine at Mount Sinai, Department of Pediatrics, Division of Allergy and Immunology, Kravis Children's Hospital, The Elliot and Roslyn Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA.
Abstract
PURPOSE OF REVIEW: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this condition has grown. RECENT FINDINGS: FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability. Management involves trigger avoidance, and patients may benefit from the support of a dietitian to ensure adequate nutrient intake. Tolerance develops over time for most children, but due to the risk of severe symptoms, re-introduction of a suspected FPIES trigger is recommended only under supervision at an oral food challenge. Studies continue to evaluate the optimal challenge protocol. Caregivers of children with FPIES report high levels of anxiety and stress, which is attributed to the dramatic symptomatology, dietary restrictions, nutritional concerns, lack of confirmatory diagnostic tests, and limited tools for management of reactions. Our understanding of the FPIES diagnosis has improved over the last few decades, but there remain opportunities, particularly regarding discerning the pathophysiology and best management practices.
PURPOSE OF REVIEW: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this condition has grown. RECENT FINDINGS: FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability. Management involves trigger avoidance, and patients may benefit from the support of a dietitian to ensure adequate nutrient intake. Tolerance develops over time for most children, but due to the risk of severe symptoms, re-introduction of a suspected FPIES trigger is recommended only under supervision at an oral food challenge. Studies continue to evaluate the optimal challenge protocol. Caregivers of children with FPIES report high levels of anxiety and stress, which is attributed to the dramatic symptomatology, dietary restrictions, nutritional concerns, lack of confirmatory diagnostic tests, and limited tools for management of reactions. Our understanding of the FPIES diagnosis has improved over the last few decades, but there remain opportunities, particularly regarding discerning the pathophysiology and best management practices.
Authors: Anna Nowak-Węgrzyn; Mirna Chehade; Marion E Groetch; Jonathan M Spergel; Robert A Wood; Katrina Allen; Dan Atkins; Sami Bahna; Ashis V Barad; Cecilia Berin; Terri Brown Whitehorn; A Wesley Burks; Jean-Christoph Caubet; Antonella Cianferoni; Marisa Conte; Carla Davis; Alessandro Fiocchi; Kate Grimshaw; Ruchi Gupta; Brittany Hofmeister; J B Hwang; Yitzhak Katz; George N Konstantinou; Stephanie A Leonard; Jennifer Lightdale; Sean McGhee; Sami Mehr; Stefano Miceli Sopo; Giovanno Monti; Antonella Muraro; Stacey Katherine Noel; Ichiro Nomura; Sally Noone; Hugh A Sampson; Fallon Schultz; Scott H Sicherer; Cecilia C Thompson; Paul J Turner; Carina Venter; A Amity Westcott-Chavez; Matthew Greenhawt Journal: J Allergy Clin Immunol Date: 2017-02-04 Impact factor: 10.793