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Food Allergy
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Alison Cassin, Ashley Devonshire, Stephanie Ward, Meghan McNeill
Non-IgE-mediated food allergies encompass immunologic adverse reactions to ingested foods without the presence of IgE. This group includes food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). Clinical symptoms, treatment, and natural history vary based on the underlying disease process; however, all non-IgE-mediated food allergies typically affect infants and young children and lack classic IgE-mediated symptoms.
Food allergies and eosinophilic gastrointestinal diseases
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
Cathryn Nagler, Glenn T. Furuta
Non-IgE (cell-mediated) food-sensitive diseases include food protein–induced enterocolitis and celiac disease, which is induced by an inappropriate response to dietary gluten (see Chapter 31 for detailed description of celiac disease). Food protein–induced enterocolitis syndrome (FPIES) is an acute life-threatening disease; the diagnosis is based on history, physical, and biochemical analysis and does not require endoscopy with biopsy. FPIES can lead to profuse diarrhea, leading to dehydration and acidosis, that is typically caused by an immune-mediated response to milk protein. The diagnosis of celiac disease is based on the history and laboratory testing, including mucosal biopsy. Symptoms of celiac disease include diarrhea, abdominal pain, and slow growth. Serological testing for specific antibody titers (antitissue transglutaminase or endomysial antibodies) and an abnormal mucosal biopsy that shows villous blunting and lymphocytic inflammation are required to make a diagnosis of celiac disease.
The Role of the Clinical Laboratory in Nutritional Assessment
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
More than 50 million Americans have an allergy. Food allergies affect 4%–6% of children and 4% of adults, according to the American College of Allergy, Asthma, and Immunology.97 Approximately eight food allergens account for 90% of all allergic sensitizations: eggs, milk, peanuts, tree nuts, fish, shellfish, wheat, and soy. Young infants in particular are susceptible to food protein-induced enterocolitis syndrome (FPIES), typically 2–6 hours after ingestion of milk, soy, and grains. Infants with FPIES often have repetitive vomiting and dehydration.
What’s next for DRACMA?
Published in Expert Review of Clinical Immunology, 2018
Lamia Dahdah, Vincenzo Fierro, Maurizio Mennini, Stefania Arasi, Alessandro Fiocchi
In the context of the epidemiological analysis of EuroPrevall, special attention was dedicated to assess the incidence of non-IgE-mediated CMA: of the 55 infants with confirmed CMA, 13 (23.6%) had no evidence of cow’s milk (CM)‐specific IgE (i.e. ImmunoCAP <0.35 kU/l and negative skin prick test), suggestive of non‐IgE‐mediated CMPA, and all of them were reported from four over the nine involved countries. These data seem really to be underestimating non IgE-mediated CMA since the incidence of milk-induced FPIES alone was 0.34% in the Israeli birth cohort. These variations reflect the different diagnostic approaches in IgE vs. non-IgE-mediated CMA (see infra). The problem is further complicated by the fact that for some forms of non-IgE-mediated milk allergy, as Food Protein Induced Enterocolitis Syndrome (FPIES), the diagnostic procedures of challenge are recommended by specific guidelines. A review of FPIES including a summary of the guidelines as well as more recent findings on the topic concluded that additional studies are needed to increase understanding of pathophysiology as well as mechanisms of different phenotypes [9].
Cow milk protein allergy and other common food allergies and intolerances
Published in Paediatrics and International Child Health, 2019
Wiparat Manuyakorn, Pornthep Tanpowpong
Within 1–3 hours of ingesting the offending food, children with FPIES present with repetitive prominent emesis and diarrhoea, followed by lethargy, an ashen appearance and hypothermia in more protracted cases. FPIES is a systemic reaction mimicking IgE-mediated anaphylaxis but there is no urticaria/angio-oedema or respiratory symptoms. Laboratory investigations demonstrate increased neutrophil and platelet counts and methemoglobinaemia in severe case [16,17].