Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock in Infants With Down Syndrome

Food protein induced enterocolitis syndrome and Down syndrome: An unexpected association?

Digestive and Liver Disease ◽

10.1016/j.dld.2017.09.069 ◽

2017 ◽

Vol 49 (4) ◽

pp. e268

Author(s):

V. Pecora ◽

M. Mennini ◽

D. Valentini ◽

L. Dahdah ◽

V. Fierro ◽

...

Keyword(s):

Down Syndrome ◽

Food Protein

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Two cases of an infant with Down syndrome with solid food protein‐induced enterocolitis syndrome

Pediatrics International ◽

10.1111/ped.14732 ◽

2021 ◽

Author(s):

Naoki Kajita ◽

Hiroshi Futagawa ◽

Hiroshi Yoshihashi ◽

Koichi Yoshida ◽

Masami Narita

Keyword(s):

Down Syndrome ◽

Solid Food ◽

Food Protein

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Food protein‐induced enterocolitis syndrome

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200011 ◽

2020 ◽

Vol 2 (1) ◽

pp. 48-54

Author(s):

Sara Anvari ◽

Carla M. Davis

Keyword(s):

Intestinal Inflammation ◽

Hypovolemic Shock ◽

Failure To Thrive ◽

Food Challenge ◽

Clinical History ◽

Intestinal Lumen ◽

Food Protein ◽

Food Ingestion ◽

Ige Mediated

Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE-mediated food allergy that primarily affects the gastrointestinal tract. The underlying pathophysiology of FPIES has yet to be fully elucidated; however, FPIES is believed to be secondary to intestinal inflammation after exposure to a food antigen, which thereby leads to increased permeability and fluid shifting into the intestinal lumen. FPIES is categorized into acute and chronic forms. Acute FPIES is characterized by repetitive vomiting that occurs 1‐4 hours after food ingestion. Severe vomiting may progress to dehydration, lethargy, and pallor, which potentially leads to hypovolemic shock. In some patients, diarrhea may present within 24-hours of food ingestion. Patients are clinically well between acute episodes. Chronic FPIES presents with intermittent vomiting and/or diarrhea, followed by failure to thrive. FPIES characteristically presents in infancy, with resolution of the disease typically occurring by school age. However, analysis of recent data indicates that FPIES may persist into adulthood. In addition, late- or adult-onset FPIES has also been reported. The diagnosis of FPIES is based on clinical history; however, oral food challenge currently remains the criterion standard for diagnosis. Management of FPIES requires strict avoidance of food triggers, and treatment requires rapid fluid rehydration. Currently, there are no reliable biomarkers to diagnose FPIES; however, investigations to better understand the role of the innate immune system have been promising. Future studies are needed to better understand the true prevalence and pathophysiology of FPIES.

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Food protein-induced enterocolitis syndrome in pediatric practice

Pediatrician (St Petersburg) ◽

10.17816/ped10269-74 ◽

2019 ◽

Vol 10 (2) ◽

pp. 69-74

Author(s):

Valeria P. Novikova ◽

Alevtina A. Pokhlebkina

Keyword(s):

Hypovolemic Shock ◽

Good Prognosis ◽

Cow Milk ◽

Laboratory Evaluation ◽

Food Protein ◽

Reactive Protein ◽

Wide Range ◽

Ige Mediated ◽

Severity Of The Disease ◽

Gastric Juice Analysis

One of non-IgE-mediated disorders that pediatricians and allergologists have to deal with is food protein-induced enterocolitis syndrome (Food Protein Induced Enterocolitis Syndrome, FPIES). Cow milk and soy proteins are the most common cause of FPIES. Other foods that can cause FPIES include a wide range of solid food stuffs, such as grains, vegetables, fruits, and poultry. Food-borne enterocolitis is usually accompanied by acute recurring vomiting and diarrhea, lethargy, pallor, dehydration, and even hypovolemic shock. FPIES often occurs after the first introduction of complementary foods containing trigger products, usually not accompanied by fever or a significant increase in the level of C-reactive protein, and generally has a good prognosis. Depending on the severity of the disease, metabolic acidosis and meth-hemoglobinemia may develop. In chronic cases anemia, hypoalbuminemia and eosinophilia may occur. In acute cases laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking 6 hours after a meal. Manifestations of FPIES usually disappear within 24-48 hours after elimination of the causative food. Radiological evaluation and other methods like endoscopy and gastric juice analysis can yield nonspecific results. Data on the incidence of FPIES is limited, and approximate assessment of affected children rate varies from 1.5 to 30 per 10,000. Further studies are needed to identify clinical subtypes and predisposing factors for the development of FPIES compared to immediate-type IgE-mediated gastroenteropathy.

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Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock and Methemoglobinemia

Case Reports in Critical Care ◽

10.1155/2018/1903787 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Stefan W. Malin ◽

Riad Lutfi ◽

Matthew L. Friedman ◽

Alicia M. Teagarden

Keyword(s):

Methylene Blue ◽

Metabolic Acidosis ◽

Fluid Resuscitation ◽

Hypovolemic Shock ◽

Dietary Change ◽

Recent Change ◽

Food Protein ◽

Healthy Male ◽

Dietary History ◽

Life Saving

A 5-week-old previously healthy male presented with vomiting and diarrhea leading to hypovolemic shock and profound metabolic acidosis. He was subsequently found to have severe methemoglobinemia. The acidosis and shock improved with fluid resuscitation and methemoglobinemia was successfully treated with methylene blue. An extensive workup, including evaluations for infectious and metabolic etiologies, was unremarkable. However, a detailed dietary history revealed a recent change in diet, supporting a diagnosis of food protein-induced enterocolitis syndrome (FPIES). We present this case to highlight the importance of considering FPIES in an infant with vomiting and diarrhea, in the setting of a recent dietary change, leading to profound dehydration, metabolic acidosis, and methemoglobinemia. Diagnosis of FPIES, although difficult to make and one of exclusion, can be potentially life-saving.

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