scholarly journals Non-IgE-mediated food allergy: Evaluation and management

2021 ◽  
Vol 26 (3) ◽  
pp. 173-176
Author(s):  
Elissa M Abrams ◽  
Kyla J Hildebrand ◽  
Edmond S Chan
Keyword(s):  
Food Allergy ◽  
High Rate ◽  
Food Protein ◽  
Acute Management ◽  
Healthy Infants ◽  
Ige Mediated ◽  
Allergic Proctocolitis ◽  
Term Management ◽  
Refractory Emesis

Abstract The most common types of non-IgE-mediated food allergy are food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). FPIES presents with delayed refractory emesis, while FPIAP presents with hematochezia in otherwise healthy infants. Acute management of FPIES includes rehydration or ondansetron, or both. No acute management is required for FPIAP. Long-term management of both disorders includes avoidance of the trigger food. The prognosis for both conditions is a high rate of resolution within a few years’ time.

Increased IgE-Mediated Food Allergy With Food Protein-Induced Allergic Proctocolitis

PEDIATRICS ◽  
2021 ◽  
Vol 148 (Supplement 3) ◽  
pp. S35-S36
Author(s):  
Monica T. Kraft ◽  
David Stukus
Keyword(s):  
Food Allergy ◽  
Food Protein ◽  
Ige Mediated ◽  
Allergic Proctocolitis

scholarly journals Increased IgE-Mediated Food Allergy With Food Protein-Induced Allergic Proctocolitis

PEDIATRICS ◽  
2020 ◽  
Vol 146 (3) ◽  
pp. e20200202
Author(s):  
Victoria M. Martin ◽  
Yamini V. Virkud ◽  
Neelam A. Phadke ◽  
Kuan-Wen Su ◽  
Hannah Seay ◽  
...  
Keyword(s):  
Food Allergy ◽  
Food Protein ◽  
Ige Mediated ◽  
Allergic Proctocolitis

Non-IgE Mediated Food Allergy

2020 ◽  
Vol 16 (2) ◽  
pp. 95-105
Author(s):  
Antonella Cianferoni
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Allergic Diseases ◽  
Food Allergies ◽  
Food Protein ◽  
Ige Mediated ◽  
Food Challenges ◽  
Allergic Proctocolitis ◽  
Eosinophilic Disorders

Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. Non-IgE mediated food allergies are being being investigated.

Non-IgE Mediated Food Allergy

2020 ◽  
Vol 16 (2) ◽  
pp. 95-105
Author(s):  
Antonella Cianferoni
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Allergic Diseases ◽  
Food Allergies ◽  
Food Protein ◽  
Ige Mediated ◽  
Food Challenges ◽  
Allergic Proctocolitis ◽  
Eosinophilic Disorders

: Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. : Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. : In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. : Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. : The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. : Non-IgE mediated food allergies are being being investigated.

scholarly journals Longitudinal disease-associated gut microbiome differences in infants with early food allergic manifestations

2021 ◽  
Author(s):  
Victoria Martin ◽  
Yamini Virkud ◽  
Ehud Dahan ◽  
Hannah Seay ◽  
Hera Vlamakis ◽  
...  
Keyword(s):  
Food Allergy ◽  
Symptom Onset ◽  
Gut Microbiome ◽  
Allergic Diseases ◽  
Structural Development ◽  
Food Protein ◽  
Mechanistic Investigation ◽  
Ige Mediated ◽  
Allergic Proctocolitis ◽  
Prospective Longitudinal

Abstract Complex interactions between the gut microbiome and immune cells in infancy are thought to be part of the pathogenesis for the marked rise in pediatric allergic diseases, particularly food allergies. Food protein-induced allergic proctocolitis (FPIAP) is commonly the earliest recognized non-IgE-mediated food allergy in infancy and is associated with atopic dermatitis and subsequent IgE-mediated food allergy later in childhood. Yet, a large prospective longitudinal study of the microbiome of infants with FPIAP (including samples prior to symptom onset) has not been done. Here we analyzed 954 longitudinal samples from 160 infants in a nested case-control study (81 who developed FPIAP, and 79 matched controls) from 1 week to 1 year of age by 16S rRNA ribosomal gene sequencing as part of the Gastrointestinal Microbiome and Allergic Proctocolitis (GMAP) Study. We confirmed that vaginally delivered infants had a greater abundance of Bacteroides, infants who received any breast milk had a greater abundance of Bifidobacterium, and that overall bacterial richness rose over the first year. We found key differences in the microbiome of infants with FPIAP, most strongly a higher abundance of a genus of Enterobacteriaceae and a lower abundance of a family of Clostridiales during the symptomatic period, as well as other key taxonomic differences across symptom states including prior to symptom onset. This study contributes to the larger body of literature examining structural development of the early life gut microbiome and provides a foundation for more mechanistic investigation into the pathogenesis and microbial effects on FPIAP and subsequent food allergic diseases in childhood.

Predictors for late tolerance development in food protein‐induced allergic proctocolitis

2020 ◽  
Vol 41 (1) ◽  
pp. e11-e18 ◽  
Author(s):  
Pınar Gur Cetinkaya ◽  
Melike Kahveci ◽  
Betül Karaatmaca ◽  
Saliha Esenboga ◽  
Umit Murat Sahiner ◽  
...  
Keyword(s):  
Food Allergy ◽  
Complementary Feeding ◽  
Immunoglobulin E ◽  
Age Of Onset ◽  
Area Under The Curve ◽  
Food Protein ◽  
Tolerance Development ◽  
Early Introduction ◽  
Ige Mediated ◽  
Allergic Proctocolitis

Background: Food protein-induced allergic proctocolitis (FPIAP) is a non‐immunoglobulin E (IgE) mediated food allergy that typically presents with blood-mixed mucoid stool. Objective: To identify the predictors that affect the tolerance development in infants with FPAIP and laboratory as well as clinical differences between patients with early and with late tolerance. Methods: A total of 185 infants with FPIAP were included. The patients were grouped and analyzed based on laboratory tests and clinical characteristics. Results: The median (interquartile range [IQR]) age of onset of symptoms was 2.0 months (1.0‐3.0 months). Symptoms began in severe cases in patients (n = 23) at a younger median (IQR) age (1.5 months [0.7‐2.0 months]) than the group with nonsevere presentation (median 2.0 months [IQR 1.5‐3.0 months]) (p < 0.001). The frequency of neutropenia (<1500/mm3) (p = 0.045) and eosinophilia (450 mm3) (p = 0.018) was increased in severe cases. Concomitant IgE-related food allergy (odds ratio [OR] 3.595 [95% confidence interval {CI}, 1.096‐11.788], p = 0.035), non‐IgE-mediated multiple food allergy (OR 3.577 [95% CI, 1.595‐8.018], p = 0.002), feeding with cow's milk‐based formula (at least once during infancy) (OR 2.517 [95% CI, 1.188‐5.333], p = 0.016), and late complementary feeding (OR 5.438 [95% CI, 2.693‐10.981], p < 0.001) were the predictors for late tolerance development. The estimated optimal cutoff value for introduction of complementary foods for the resolution of allergy was 5.5 months, with 69.4% sensitivity, 74.4% specificity, and an area under the curve of 0.737 (95% CI, 0.626‐0.812) (p < 0.001). Conclusion: This study showed that the early introduction of complementary feeding accelerates tolerance development in FPAIP. A longer duration of an elimination diet has no impact on the resolution of allergy. Physicians should consider conservative avoidance measures and earlier introduction of complementary feeding in FPIAP.

Idiopathic anaphylaxis: Diagnosis and management

2021 ◽  
Vol 42 (6) ◽  
pp. 481-488 ◽  
Author(s):  
Alyssa G. Burrows ◽  
Anne K. Ellis
Keyword(s):  
Food Allergy ◽  
Immunoglobulin E ◽  
Treatment Options ◽  
Serum Tryptase ◽  
Genetic Trait ◽  
Baseline Serum ◽  
Diagnostic Technologies ◽  
Term Management ◽  
Idiopathic Anaphylaxis

Introduction: Idiopathic anaphylaxis (IA) is a diagnosis of exclusion and is based on the inability to identify a causal relationship between a trigger and an anaphylactic event, despite a detailed patient history and careful diagnostic assessment. The prevalence of IA among the subset of people who experienced anaphylaxis is challenging to estimate and varies widely, from 10 to 60%; most commonly noted is ∼20% in the adult anaphylactic population. Comorbid atopic conditions, such as food allergy, allergic rhinitis, and asthma, are present in up to 48% of patients with IA. Improved diagnostic technologies and an increased understanding of conditions that manifest with symptoms associated with anaphylaxis have improved the ability to determine a more accurate diagnosis for patients who may have been initially diagnosed with IA. Methods: Literature search was conducted on PubMed, Google Scholar and Embase. Results: Galactose-α-1,3-galactose (α-gal) allergy, mast cell disorders, and hereditary a-tryptasemia are a few differential diagnoses that should be considered in patients with IA. Unlike food allergy, when anaphylaxis occurs within minutes to 2 hours after allergen consumption, α-gal allergy is a 3‐6-hour delayed immunoglobulin E‐mediated anaphylactic reaction to a carbohydrate epitope found in red meat (e.g., beef, lamb, pork). The more recently described hereditary α-tryptasemia is an inherited autosomal dominant genetic trait caused by increased germline copies of tryptase human gene alpha-beta 1 (TPSAB1), which encodes α tryptase and is associated with elevated baseline serum tryptase. Acute management of IA consists of carrying an epinephrine autoinjector to be administered immediately at the first signs of anaphylaxis. Long-term management for IA with antihistamines and other agents aims to potentially reduce the frequency and severity of the anaphylactic reactions, although the evidence is limited. Biologics are potentially steroid-sparing for patients with IA; however, more research on IA therapies is needed. Conclusion: The lack of diagnostic criteria, finite treatment options, and intricacies of making a differential diagnosis make IA challenging for patients and clinicians to manage.

scholarly journals Atypical Food protein-induced enterocolitis syndrome in children: Is IgE sensitization an issue longitudinally?

2021 ◽  
Vol 49 (3) ◽  
pp. 73-82
Author(s):  
Athina Papadopoulou ◽  
Theano Lagousi ◽  
Elpiniki Hatzopoulou ◽  
Paraskevi Korovessi ◽  
Stavroula Kostaridou ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Allergic Diseases ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk ◽  
T Helper 2 ◽  
Term Evaluation ◽  
Ige Mediated ◽  
Trigger Mechanisms

Background: Food Protein-Induced Enterocolitis Syndrome (FPIES) is a clinically well-characterised, non-Immunoglobulin E (IgE)-mediated food allergy syndrome, yet its rare atypical presen-tation remains poorly understood.Objective: Aim of this study was to present the 10-year experience of a referral centre high-lighting the atypical FPIES cases and their long-term outcome.Methods: FPIES cases were prospectively evaluated longitudinally in respect of food outgrowth and developing other allergic diseases with or without concomitant IgE sensitisation.Results: One hundred subjects out of a total of 14,188 referrals (0.7%) were identified. At pre-sentation, 15 patients were found sensitised to the offending food. Fish was the most frequent eliciting food, followed by cow’s milk and egg. Tolerance acquisition was earlier for cow’s milk, followed by egg and fish, while found not to be protracted in atypical cases. Resolution was not achieved in half of the fish subjects during the 10-year follow-up time. Sensitisation to food was not related to infantile eczema or culprit food, but was related to sensitisation to aeroallergens. In the long-term evaluation, persistence of the FPIES or aeroallergen sensitisation was significantly associated with an increased hazard risk of developing early asthma symptoms. Conclusion: Sensitisation to food was related neither to eczema or culprit food nor to tolerance acquisition but rather to the development of allergic asthma through aeroallergen sen-sitisation. In addition to an IgE profile at an early age, FPIES persistence may also trigger mechanisms switching FPIES cases to a T-helper 2 cells immune response later in life, predis-posing to atopic respiratory symptoms; albeit further research is required.

Sign in / Sign up

Export Citation Format

Share Document