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[Food protein-induced enterocolitis syndrome (FPIES) in 14 children].
Arch Pediatr 2017; 24(4):310-316AP

Abstract

INTRODUCTION

Food protein-induced enterocolitis syndrome (FPIES) is a particular non-IgE-mediated food allergy, manifested by profuse and repetitive vomiting with hypotonia and lethargy in its acute form.

METHODS

A retrospective descriptive single-center study was conducted. Subjects included in this study were children with acute FPIES who consulted the allergy outpatient clinic of the Nancy Regional University Hospital between November 2013 and June 2016.

RESULTS

Among the 14 patients (eight boys and six girls), nine had a history of atopy: a family history for six (42.8%) and a personal history for five (35.7%). Three had chronic FPIES turning into acute FPIES. Cow milk was the most common triggering food (50%), followed by fish (21.4%), mussels (14.3%), wheat (7.1%), egg (7.1%), and poultry (7.1%). The average time from ingestion to symptom onset was 90minutes. The symptoms were typical and diarrhea was not systematic (42.8%). Six children were hospitalized, some of them several times, including once in intensive care for one patient. The treatments established were, in order of frequency: oral or intravenous rehydration, corticosteroids, antihistamines, and antiemetics. Diagnosis time was 7.6 months on average; it was significantly shorter for milk than for solid foods (1.4 vs. 12 months, P-value=0.02), on average after two episodes. Another diagnosis than FPIES was raised at first for five patients (acute gastroenteritis, gastroesophageal reflux, and bowel obstruction caused by bowel volvulus). Allergy tests were initially negative. Two chronic FPIES cases (one milk FPIES and one milk and wheat FPIES) developed an acute FPIES to another food (fish and mussels); one patient changed from an acute fish FPIES to an IgE-mediated phenotype over time. FPIES resolved for four patients: three milk FPIES, on average 15.7 months after the first reaction, and one wheat FPIES, 2.5 years after the first reaction. A child with a white fish FPIES was able to introduce salmon and tuna.

CONCLUSION

FPIES is a pathology that has suffered from a lack of knowledge, delaying diagnosis for many months. The progression of chronic forms to acute forms and acute forms to an IgE-mediated allergy is not rare. Doctors need more detailed knowledge: profuse and repetitive vomiting accompanied by hypotonia and/or lethargy should suggest the diagnosis of acute FPIES. To improve the management of acute FPIES, a treatment protocol is proposed here.

Authors+Show Affiliations

Unité d'allergologie pédiatrique, service de médecine infantile, hôpital d'Enfants, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France. Electronic address: c.delahaye@chru-nancy.fr.Unité d'allergologie pédiatrique, service de médecine infantile, hôpital d'Enfants, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.Unité d'allergologie pédiatrique, service de médecine infantile, hôpital d'Enfants, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France; Service de pédiatrie, hôpital Femme-Mère-Enfant, 1, allée du Château, 57085 Metz, France.Unité d'allergologie pédiatrique, service de médecine infantile, hôpital d'Enfants, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.

Pub Type(s)

Journal Article

Language

fre

PubMed ID

28233719

Citation

Delahaye, C, et al. "[Food Protein-induced Enterocolitis Syndrome (FPIES) in 14 Children]." Archives De Pediatrie : Organe Officiel De La Societe Francaise De Pediatrie, vol. 24, no. 4, 2017, pp. 310-316.
Delahaye C, Chauveau A, Kiefer S, et al. [Food protein-induced enterocolitis syndrome (FPIES) in 14 children]. Arch Pediatr. 2017;24(4):310-316.
Delahaye, C., Chauveau, A., Kiefer, S., & Dumond, P. (2017). [Food protein-induced enterocolitis syndrome (FPIES) in 14 children]. Archives De Pediatrie : Organe Officiel De La Societe Francaise De Pediatrie, 24(4), pp. 310-316. doi:10.1016/j.arcped.2017.01.011.
Delahaye C, et al. [Food Protein-induced Enterocolitis Syndrome (FPIES) in 14 Children]. Arch Pediatr. 2017;24(4):310-316. PubMed PMID: 28233719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Food protein-induced enterocolitis syndrome (FPIES) in 14 children]. AU - Delahaye,C, AU - Chauveau,A, AU - Kiefer,S, AU - Dumond,P, Y1 - 2017/02/21/ PY - 2016/07/22/received PY - 2016/11/15/revised PY - 2017/01/03/accepted PY - 2017/2/25/pubmed PY - 2018/2/21/medline PY - 2017/2/25/entrez SP - 310 EP - 316 JF - Archives de pediatrie : organe officiel de la Societe francaise de pediatrie JO - Arch Pediatr VL - 24 IS - 4 N2 - INTRODUCTION: Food protein-induced enterocolitis syndrome (FPIES) is a particular non-IgE-mediated food allergy, manifested by profuse and repetitive vomiting with hypotonia and lethargy in its acute form. METHODS: A retrospective descriptive single-center study was conducted. Subjects included in this study were children with acute FPIES who consulted the allergy outpatient clinic of the Nancy Regional University Hospital between November 2013 and June 2016. RESULTS: Among the 14 patients (eight boys and six girls), nine had a history of atopy: a family history for six (42.8%) and a personal history for five (35.7%). Three had chronic FPIES turning into acute FPIES. Cow milk was the most common triggering food (50%), followed by fish (21.4%), mussels (14.3%), wheat (7.1%), egg (7.1%), and poultry (7.1%). The average time from ingestion to symptom onset was 90minutes. The symptoms were typical and diarrhea was not systematic (42.8%). Six children were hospitalized, some of them several times, including once in intensive care for one patient. The treatments established were, in order of frequency: oral or intravenous rehydration, corticosteroids, antihistamines, and antiemetics. Diagnosis time was 7.6 months on average; it was significantly shorter for milk than for solid foods (1.4 vs. 12 months, P-value=0.02), on average after two episodes. Another diagnosis than FPIES was raised at first for five patients (acute gastroenteritis, gastroesophageal reflux, and bowel obstruction caused by bowel volvulus). Allergy tests were initially negative. Two chronic FPIES cases (one milk FPIES and one milk and wheat FPIES) developed an acute FPIES to another food (fish and mussels); one patient changed from an acute fish FPIES to an IgE-mediated phenotype over time. FPIES resolved for four patients: three milk FPIES, on average 15.7 months after the first reaction, and one wheat FPIES, 2.5 years after the first reaction. A child with a white fish FPIES was able to introduce salmon and tuna. CONCLUSION: FPIES is a pathology that has suffered from a lack of knowledge, delaying diagnosis for many months. The progression of chronic forms to acute forms and acute forms to an IgE-mediated allergy is not rare. Doctors need more detailed knowledge: profuse and repetitive vomiting accompanied by hypotonia and/or lethargy should suggest the diagnosis of acute FPIES. To improve the management of acute FPIES, a treatment protocol is proposed here. SN - 1769-664X UR - https://www.unboundmedicine.com/medline/citation/28233719/[Food_protein_induced_enterocolitis_syndrome__FPIES_ in_14_children]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0929-693X(17)30037-4 DB - PRIME DP - Unbound Medicine ER -