Latest Insights on Food Protein-Induced Enterocolitis Syndrome: An Emerging Medical Condition.

Food protein-induced enterocolitis syndrome (FPIES) is a type of non-IgE-mediated gastrointestinal food hypersensitivity characterized by profuse vomiting that is frequently associated with pallor or/and lethargy and appears within 1 to 3 hours after ingestion of the offending food. A less frequent chronic form of FPIES is characterized by protracted vomiting, diarrhea, or both accompanied by poor growth. Although FPIES is considered a rare allergic disorder, increasing reports in recent years point to a real increase in incidence, or at least an increased awareness of this condition by pediatricians. The foods most frequently implicated are cow's milk, soy formula, grains, and fish, depending on the geographic area. Diagnosis is based on clinical manifestations and requires a high index of suspicion, since we still lack a diagnostic laboratory tool. Early recognition of FPIES and removal of the offending food are mandatory. International consensus guidelines on diagnosis and management have been published. Prognosis is usually good, with most children tolerating foods before 6 years of age.

Latest insights on food protein-induced enterocolitis syndrome: an emerging medical condition

Food protein-induced enterocolitis syndrome (FPIES) is a type of non-IgE-mediated gastrointestinal food hypersensitivity characterized by profuse vomiting that is frequently associated with pallor or/and lethargy and appears within 1 to 3 hours after ingestion of the offending food. A less frequent chronic form of FPIES is characterized by protracted vomiting, diarrhea, or both accompanied by poor growth. Although FPIES is considered a rare allergic disorder, increasing reports in recent years point to a real increase in incidence, or at least an increased awareness of this condition by pediatricians. The foods most frequently implicated are cow’s milk, soy formula, grains, and fish, depending on the geographic area. Diagnosis is based on clinical manifestations and requires a high index of suspicion, since we still lack a diagnostic laboratory tool. Early recognition of FPIES and removal of the offending food are mandatory. International consensus guidelines on diagnosis and management have been published. Prognosis is usually good, with most children tolerating foods before 6 years of age (AU)

La enterocolitis inducida por proteínas de alimentos es un tipo de enfermedad alérgica gastrointestinal no mediada por IgE. Se caracteriza por vómitos profusos, frecuentemente asociados a palidez y/o letargia que aparece 1-3 horas después de la ingesta del alimento al que el paciente se encuentra sensibilizado. Existe otra forma menos frecuente y más larvada o crónica, caracterizada por vómitos persistentes y/o diarrea, asociados a fallo de medro. Aunque se considera una patología alérgica infrecuente, en los últimos años se ha incrementado el número de publicaciones sobre este tema, indicando si no un incremento real en su incidencia, al menos un incremento en el conocimiento que los pediatras y alergólogos tienen sobre esta enfermedad. Los alimentos implicados con mayor frecuencia son leche de vaca, soja, cereales y pescado, dependiendo de las distintas zonas geográficas. El diagnóstico se fundamenta en la clínica y por tanto requiere un alto índice de sospecha, dado que no existe ninguna prueba de laboratorio que sea definitiva. Una vez establecido el diagnóstico, es fundamental retirar el alimento de la dieta. Recientemente ha sido publicado un consenso internacional de expertos, en el que se revisa en profundidad el diagnóstico y tratamiento de la enterocolitis. El pronóstico suele ser bueno, ya que la mayoría de los niños llegan a tolerar el alimento antes de los 6 años (AU)

Parotiditis recurrente juvenil y déficit de células natural killer / Juvenile recurrent parotitis and natural killer cells deficiency

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Delayed reaction to cow's milk proteins: a case study.

Allergy to cow's milk proteins has been defined as any adverse reaction mediated by immunological mechanisms to one or several of these proteins. The diagnosis can be made based on clinical manifestations supported by immune activation of in vitro parameters. Reactions to cow's milk have been classified according on their onset as immediate (< 45 min) or delayed-type (from 2 h to days). We describe a patient with late respiratory manifestations after milk intake, probably due to more than one immunological mechanism. He was an 18-year-old male who since infancy had presented serous rhinorrea, sneezing, nasal blockade, oropharyngeal pruritus and occasional dyspnea 12 to 48 h after ingestion of milk and its derivates. We performed skin prick and intradermal tests with whole milk and fractions. Patch tests were also carried out with whole milk purchased at a supermarket and with the extracts described, in their original form and vehiculized in vaseline. Total and serum specific IgE and IgG4 to milk fractions, histamine release test (HRT) to milk fractions, and precipitating antibodies by contraimmunoelectrophoresis against milk fractions were also measured. As a control we repeated this test in a patient with IgE-mediated manifestations to milk proteins and in two healthy controls. We performed a single-blind placebo controlled challenge with whole milk. Skin prick and intradermal tests were negative. Patch test (48 h) was positive for whole milk and whole milk vehiculized in vaseline, and for alpha-lactalbumin. Total IgE was 559 kU/l; serum-specific IgE was negative; IgG4 was positive (9.48% for alpha-lactalbumin; 7.41% for beta-lactoglobulin and 9.85% for casein). HRT was positive for casein (34%). We found precipitating antibodies to the three milk fractions in our patient and in the atopic control. In the challenge test, 10 h after milk intake the patient presented serous rhinorrea, sneezing and nasal blockade. IgG4 was involved as a blocking or anaphylactic antibody and as an immunological epiphenomenon reflecting a permanent antigenic stimulus. We find this last explanation to be the most coherent in this case.