• Clinico-paraclinical features of the course of food4induced enterocolytic syndrome in young children

Clinico-paraclinical features of the course of food4induced enterocolytic syndrome in young children

PERINATOLOGY AND PEDIATRIC. UKRAINE. 2018.4(76):99-105; doi 10.15574/PP.2018.76.99
Haiduchik H. A.
SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine», Kyiv

Purpose — to study the clinical and paraclinical features of the course of food-induced enterocolic syndrome in young children.

Patients and methods. A comprehensive examination was performed on 24 children aged 2 months to 3 years with induced food proteins with enterocolitis syndrome, which included: general-clinical examination; determination of the levels of total IgE and specific IgE antibodies to food allergens by the ImmunoCAP method; staging of diagnostic patch tests; determination of the concentration of TNF-α in serum by the IFA method; instrumental research (colonoscopy with biopsy) with clear indications. The results of the received data were processed statistically.

Results. Induced food proteins enterocolitis syndrome had a chronic course. Characteristic symptoms were vomiting or diarrhea between feeding, diarrhea with admixture of mucus and blood, flatulence, intense colic and delayed physical development. The most common allergen was the protein of cow's milk, which is confirmed by the positive result of oral provocative test. The increase in the concentration of TNF-α in the blood serum of the examined patients was revealed, which indicates the activation of cell-mediated proinflammatory processes that trigger chronic allergic inflammation.

Conclusions. The diagnosis of enterocoly-induced food proteins is clinically established and requires differential diagnosis with a wide range of diseases due to the nonspecific clinical symptoms. In the case of an atypical course, the golden standard of diagnosis is the conduct of open oral provocative test, and the setting of patch tests is a useful additional method of diagnosis of hypersensitivity of the slowed-down type.

Key words: children of young age, food-induced enterocolitis syndrome, non-IgE-mediated allergy, oral provocative test.

REFERENCES

1. Baker RD, Greer FR. (2010). Committee on nutrition American Academy of P. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0—3 years of age). Pediatrics. 126(5): 1040—1050. https://doi.org/10.1542/peds.2010-2576; PMid:20923825

2. Banzato C, Piacentini GL, Comberiati P, Mazzei F, Boner AL, Peroni DG. (2013). Unusual shift from IgE-mediated milk allergy to food protein-in-duced enterocolitis syndrome. Eur Ann Allergy Clin Immunol. 45(6): 209—211. PMid:24619083

3. Caubet JC, Bencharitiwong R, Ross A, Sampson HA, Berin MC, Nowak-Wegrzyn A. (2017). Humoral and cellular responses to casein in patients with food protein-induced enterocolitis to cow's milk. J Allergy Clin Immunol. 139(2): 572—583. https://doi.org/10.1016/j.jaci.2016.02.047; PMid:27545065

4. Caubet JC, Ford LS, Sickles L et al. (2014). Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 134(2): 382—389. https://doi.org/10.1016/j.jaci.2014.04.008; PMid:24880634

5. Gonzalez-Delgado P, Caparros E, Moreno MV et al. (2016). Clinical and immunological characteristics of a pediatric population with food protein-induced enterocolitis syndrome (FPIES) to fish. Pediatr Allergy Immunol. 27(3): 269—275. https://doi.org/10.1111/pai.12529; PMid:26681231

6. Holbrook T, Keet CA, Frischmeyer-Guerrerio PA, Wood RA. (2013). Use of ondansetron for food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 132(5): 1219—1220. https://doi.org/10.1016/j.jaci.2013.06.021; PMid:23890754

7. Hwang J-B, Song J-Y, Kang YN et al. (2008). The significance of gastric juice analysis for a positive challenge by a standard oral challenge test n typical cow's milk protein-induced enterocolitis. J Korean Med Sci. 23(2): 251—255. https://doi.org/10.3346/jkms.2008.23.2.251; PMid:18437008 PMCid:PMC2526446

8. Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. (2011). 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. 127(3): 647—653, e641—643.

9. Kimura M, Ito Y, Tokunaga F et al. (2016). Increased C-reactive protein and fever in Japanese infants with food protein-induced enterocolitis syndrome. Pediatr Int. 58(9): 826—830. https://doi.org/10.1111/ped.13036; https://doi.org/10.1111/ped.12938; PMid:26824628

10. Kimura M, Shimomura M, Morishita H, Meguro T, Seto S. (2016). Serum C-Reactive protein in food protein-induced enterocolitis syndrome versus food protein-induced proctocolitis in Japan. Pediatr Int. 58(9): 836—841. https://doi.org/10.1111/ped.13036; https://doi.org/10.1111/ped.12938

11. Mehr S, Frith K, Barnes EH, Campbell DE, FPIES Study Group. (2017, Nov). Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012—2014. J allergy Clin Immunol. 140(5): 1323—1330. https://doi.org/10.1016/j.jaci.2017.03.027.

12. Mehr S, Kakakios A, Frith K, Kemp AS. (2009). Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 123(3): e459—464. https://doi.org/10.1542/peds.2008-2029; PMid:19188266

13. Miceli Sopo S, Battista A, Greco M, Monaco S. (2014). Ondansetron for food protein-induced enterocolitis syndrome. Int Arch Allergy Immunol. 164(2): 137—139. https://doi.org/10.1159/000363384; PMid:24993542

14. Nomura I, Morita H, Hosokawa S et al. (2011). Four distinct subtypes of non-IgE-mediated gastrointestinal food allergies in neonates and infants, distinguished by their initial symptoms. J Allergy Clin Immunol. 127(3): 685—688. e681—688.

15. Nowak-Wegrzyn A, Chehade M, Groetch ME et al. (2017). 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. 139(4): 1111—1126, e1114.

16. Pecora V, Prencipe G, Valluzzi R et al. (2017). Inflammatory events during food protein-induced enterocolitis syndrome reactions. Pediatr Allergy Immunol. 28(5): 464—470. https://doi.org/10.1111/pai.12723; PMid:28375580

17. Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, Spergel JM. (2013). Food protein-induced enterocolitis syndrome: insights from review of a large referral population. The Journal of Allergy and Clinical Immunology Practice. 1(4): 343—349. https://doi.org/10.1016/j.jaip.2013.05.011; PMid:24565539

18. Sicherer SH. (2005). Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. 115(1): 149—156. https://doi.org/10.1016/j.jaci.2004.09.033; PMid:15637562

Article received: Aug 30, 2018. Accepted for publication: Nov 29, 2018.