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Recurrent Sepsis-Like Episodes

  • Purificacion Gonzalez-Delgado
  • Javier FernandezEmail author
Chapter

Practical Points

  • Food-protein induced enterocolitis syndrome (FPIES) is a non-IgE mediated allergic disorder that typically occurs in infancy, characterized by profuse vomiting and diarrhea and even lethargy

  • Symptoms appear 1–4 h after food intake

  • Cow’s milk, soy and grains are the most common triggers for FPIES

  • Most patients recover at 2 or 3 years of age, but the development of specific IgE and solid-food FPIES report of a poor prognosis and prolonged course

  • Diagnosis is based on clinical history, exclusion of other causes and oral food challenge

  • Differential diagnoses include sepsis, acute gastrointestinal infection, surgical emergencies, metabolic and neurological disorders and other types of food allergy

  • Although FPIES is considered to be a result of T-cell-mediated disorder, the pathophysiology is not well known

  • The acute phase of severe FPIES must be treated with aggressive fluid resuscitation as a state of shock

Keywords

Food-protein induced enterocolitis syndrome Specific IgE Oral food challenge Adrenaline 

References

  1. 1.
    Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. 2005;115(1):149–56.CrossRefGoogle Scholar
  2. 2.
    Sicherer SH. Food protein-induced enterocolitis syndrome: clinical perspectives. J Pediatr Gastroenterol Nutr. 2000;30(Suppl):S45–9.CrossRefGoogle Scholar
  3. 3.
    Mehr S, Frith K, Campbell DE. Epidemiology of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):208–16.CrossRefGoogle Scholar
  4. 4.
    Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow’s milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011;127(3):647–53.e1-3.CrossRefGoogle Scholar
  5. 5.
    Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123(3):e459–64.CrossRefGoogle Scholar
  6. 6.
    Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111(4 Pt 1):829–35.CrossRefGoogle Scholar
  7. 7.
    Gonzalez-Delgado P, Caparros E, Moreno MV, Clemente F, Flores E, Velasquez L, Rubio G, Fernandez J. Clinical and immunological characteristics of a pediatric population with food protein-induced enterocolitis syndrome (FPIES) to fish. Pediatr Allergy Immunol. 2016;27(3):269–75.CrossRefGoogle Scholar
  8. 8.
    Miceli Sopo S, Monaco S, Badina L, Barni S, Longo G, Novembre E, Viola S, Monti G. Food protein-induced enterocolitis syndrome caused by fish and/or shellfish in Italy. Pediatr Allergy Immunol. 2015;26(8):731–6.CrossRefGoogle Scholar
  9. 9.
    Goswami R, Blazquez AB, Kosoy R, Rahman A, Nowak-Wegrzyn A, Berin MC. Systemic innate immune activation in food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2017;139(6):1885–96.e9.CrossRefGoogle Scholar
  10. 10.
    Caubet JC, Ford LS, Sickles L, Jarvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134(2):382–9.CrossRefGoogle Scholar
  11. 11.
    Nowak-Wegrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, Atkins D, Bahna S, Barad AV, Berin C, Brown Whitehorn T, Burks AW, Caubet JC, Cianferoni A, Conte M, Davis C, Fiocchi A, Grimshaw K, Gupta R, Hofmeister B, Hwang JB, Katz Y, Konstantinou GN, Leonard SA, Lightdale J, McGhee S, Mehr S, Sopo SM, Monti G, Muraro A, Noel SK, Nomura I, Noone S, Sampson HA, Schultz F, Sicherer SH, Thompson CC, Turner PJ, Venter C, Westcott-Chavez AA, Greenhawt M. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-workgroup report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111–26.e4.CrossRefGoogle Scholar
  12. 12.
    Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123(6 Suppl):S365–83.CrossRefGoogle Scholar
  13. 13.
    Maloney J, Nowak-Wegrzyn A. Educational clinical case series for pediatric allergy and immunology: allergic proctocolitis, food protein-induced enterocolitis syndrome and allergic eosinophilic gastroenteritis with protein-losing gastroenteropathy as manifestations of non-IgE-mediated cow’s milk allergy. Pediatr Allergy Immunol. 2007;18(4):360–7.CrossRefGoogle Scholar
  14. 14.
    Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. 2006;17(5):351–5.CrossRefGoogle Scholar
  15. 15.
    Jarvinen KM, Caubet JC, Sickles L, Ford LS, Sampson HA, Nowak-Wegrzyn A. Poor utility of atopy patch test in predicting tolerance development in food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol. 2012;109(3):221–2.CrossRefGoogle Scholar
  16. 16.
    Fiocchi A, Claps A, Dahdah L, Brindisi G, Dionisi-Vici C, Martelli A. Differential diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):246–54.CrossRefGoogle Scholar
  17. 17.
    Murch SH. Cow’s-milk protein as a specific immunological trigger of necrotising enterocolitis--or food protein-induced enterocolitis syndrome in disguise? J Pediatr Gastroenterol Nutr. 2013;56(1):3–4.CrossRefGoogle Scholar
  18. 18.
    Pandya S, Heiss K. Pyloric stenosis in pediatric surgery: an evidence-based review. Surg Clin North Am. 2012;92(3):527–39. vii–viii.CrossRefGoogle Scholar
  19. 19.
    Jayasooriya S, Fox AT, Murch SH. Do not laparotomize food-protein-induced enterocolitis syndrome. Pediatr Emerg Care. 2007;23(3):173–5.CrossRefGoogle Scholar
  20. 20.
    Caubet JC, Nowak-Wegrzyn A. Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome. Expert Rev Clin Immunol. 2011;7(3):317–27.CrossRefGoogle Scholar
  21. 21.
    Caubet JC, Bencharitiwong R, Ross A, Sampson HA, Berin MC, Nowak-Wegrzyn A. Humoral and cellular responses to casein in patients with food protein-induced enterocolitis to cow’s milk. J Allergy Clin Immunol. 2017;139(2):572–83.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Purificacion Gonzalez-Delgado
    • 1
  • Javier Fernandez
    • 1
    • 2
    Email author
  1. 1.Allergy SectionAlicante University General Hospital-ISABIALAlicanteSpain
  2. 2.Department of Clinical MedicineMiguel Hernandez UniversityAlicanteSpain

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