New FPIES Research

Spotlight on FPIES in Current Opinion in Allergy and Immunology

We are pleased to announce the release of the largest single publication ever on Food Protein-Induced Enterocolitis Syndrome (FPIES). This special edition of Current Opinion in Allergy and Immunology (June 2014-Volume 14-Issue 3) reviews the current understanding of FPIES and highlights areas in need of advancement. Special thanks to members of IAFFPE's Medical Advisory Board and Executive Board who contributed articles.

These articles are available free for both physicians and families. Thank you to Nutricia for making this possible and for sharing in our effort to raise FPIES awareness!

Editorial: Unmet needs in food protein-induced enterocolitis syndrome
Wang, Julie; Fiocchi, Alessandro

Clinical manifestations of food protein-induced enterocolitis syndrome
Mane, Shikha K.; Bahna, Sami L.

Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome
Feuille, Elizabeth; Nowak-Wegrzyn, Anna

Differential diagnosis of food protein-induced enterocolitis syndrome
Fiocchi, Alessandro; Claps, Alessia; Dahdah, Lamia; More

Nutritional management of food protein-induced enterocolitis syndrome
Venter, Carina; Groetch, Marion

Food protein-induced enterocolitis syndrome from the parent perspective
Schultz, Fallon; Westcott-Chavez, Amity

Epidemiology of food protein-induced enterocolitis syndrome
Mehr, Sam; Frith, Katie; Campbell, Dianne E.

Natural history of food protein-induced enterocolitis syndrome
Katz, Yitzhak; Goldberg, Michael R.

Clinical management of food protein-induced enterocolitis syndrome
Miceli Sopo, Stefano; Dello Iacono, Iride; Greco, Monica; More

It's exciting to see new, solid FPIES research published recently that is helping to shape our understanding of this condition. Listed below are new medical journal articles published by members of our esteemed Medical Advisory Board.

As part of our dedication to new research, IAFFPE was proud to help fund the study for the following article:

Food protein-induced enterocolitis syndrome: Insights from review of a large referral population.
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Abstract

Background Food protein–induced enterocolitis (FPIES) is a rare non-IgE mediated disease. Most studies have been limited in nature, with the largest cohort being 66 patients. The most common foods that have been reported are milk and soy.

Objective A retrospective chart review of patients seen in the Allergy Section at The Children's Hospital of Philadelphia with International Classification of Diseases Ninth Revision code of 558.3 (Allergic Gastroenteritis and Colitis) between 2007 and 2012 was conducted to identify patients with suspected FPIES. Diagnosis of FPIES was confirmed based on meeting clinical criteria of delayed reaction with pronounced vomiting and/or diarrhea. Data regarding patient characteristics and features of their reactions were collected for analysis and comparison with existing studies.

Results A total of 462 cases were identified in our chart review. Patients had a similar demographic profile to the normal allergy patients seen in our clinic. The most common foods identified were milk (67%), soy (41%), rice (19%), oat (16%), and egg (11%). Patients had onset of FPIES to milk and soy around 7 months of age compared with 12 months of age for solid foods. FPIES reactions were identified to meats, tree nuts, peanuts, fruits, and vegetables; 70% of the patients reacted to one or two foods. Skin prick testing and atopy patch testing were not helpful in identifying the foods.

Conclusion FPIES reactions were seen more frequently than previously described. However, the presentation and clinical features were similar to previous reports. Milk- and soy-triggered FPIES were common, and 43.5% of patients who had a milk trigger reacted to soy. There is no laboratory test to identify foods that cause FPIES, and clinician-supervised oral food challenge is the only definitive test available.

Funding Institutional support from the Department of Pediatrics and the CHOP Food Allergy Family Research Fund, International Association for Food Protein Induced Enterocolitis.

Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, Spergel JM. Food protein-induced enterocolitis syndrome: Insights from review of a large referral population. J Allergy Clin Immunol: In Practice 2013;1:343-9. http://dx.doi.org/10.1016/j.jaip.2013.05.011

Food protein-induced enterocolitis syndrome to trivial oral mucosal contact.
Download Full Article Here

Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, Spergel JM. Food protein-induced enterocolitis syndrome: Insights from review of a large referral population. J Allergy Clin Immunol: In Practice 2013;1:343-9. http://dx.doi.org/10.1016/j.jaip.2013.05.011

Abstract Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated gastrointestinal food hypersensitivity, mostly in infants. Patients usually present very ill and often misdiagnosed as acute gastroenteritis, sepsis, ileus, metabolic disorders, necrotizing enterocolitis, or severe gastroesophageal reflux disease. We present a case of an infant who had three acute FPIES episodes: the first was at 5 months of age after chewing on a cellophane wrapper, the second was due to sweet potato, and the third was due to rice cereal. It was realized that in the first episode, the wrapper was covering a rice cake. Evaluation at 7 months of age, while asymptomatic, showed normal complete blood count, low serum immunoglobulin E level, and negative allergy skin prick tests, indicating non-IgE sensitivity. Conclusion: This case of FPIES has peculiar features in that it occurred in an exclusively breastfed infant and by non-ingestant oral contact with a trivial quantity of rice allergen.

Shikha K. Mane, Margaret E. Hollister, Sami L. Bahna. Food protein-induced enterocolitis syndrome to trivial oral mucosal contact. European Journal of Pediatrics. 2013 May 29. http://link.springer.com/article/10.1007/s00431-013-2051-2

The Artis Laboratory at the Perelman School of Medicine at University of Pennsylvania in conjunction with Drs. Spergel, Brown-Whitehorn and Cianferoni at The Children's Hospital of Philadelphia are exploring the mechanisms that contribute to FPIES reaction. They will be exploring the cellular and molecular changes that occur during FPIES reactions.

The goals of this research are to have better understanding of the causes of FPIES and eventually better diagnostics for the prevention and treatment of FPIES.

CHOP is accepting calls to be added to a database of potentially interested participants. For more information, please contact: Kathy Pinzone, Research Coordinator, Children's Hospital of Philadelphia, Department of Allergy and Immunology at (215)-590-2549.

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