The prevalence and natural course of food protein–induced enterocolitis syndrome to cow’s milk: A large-scale, prospective population-based study - 10/08/11
, Michael R. Goldberg, MD, PhD a, Nelly Rajuan, MSc b, Adi Cohen, MD a, Moshe Leshno, MD, PhD c
Reprint requests: Yitzhak Katz, MD, Institute of Allergy and Immunology, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.Abstract |
Background |
The prevalence and natural history for food protein–induced enterocolitis syndrome (FPIES) have not been determined.
Objective |
We sought to determine the prevalence, clinical manifestations, and rate of recovery for FPIES in a large-scale, population-based prospective study.
Methods |
In a prospective study the feeding history of 13,019 infants was obtained. Infants with probable adverse reactions to cow’s milk protein (CMP) were clinically examined, skin prick tested, and challenged orally. Diagnostic criteria for CMP-induced FPIES included age less than 9 months, delayed recurrent vomiting (usually with nausea), and lethargy after exposure to CMP in the absence of other IgE-mediated symptoms, such as rash, urticaria, and respiratory symptoms. In addition, a positive challenge response to milk resulted in the above-mentioned gastrointestinal symptoms, removal of milk from the diet resulted in the resolution of those symptoms, or both.
Results |
Ninety-eight percent of the cohort participated in the study. The cumulative incidence for FPIES was 0.34% (44/13,019 patients). The most common symptoms were recurrent vomiting (100%), lethargy (77%) diarrhea (25%), pallor (14%), and bloody diarrhea (4.5%). All patients had FPIES within the first 6 months of life. By the age of 3 years, 90% of the patients had recovered. We did not detect any concomitant reaction to soy. Eight patients with FPIES had IgE-mediated cow’s milk allergy (IgE-CMA).
Conclusions |
The prevalence of FPIES is significant, and its clinical presentation is distinct from that of IgE-CMA. Most patients with FPIES recover, although a proportion might convert to IgE-CMA. The likelihood for a cross-reactivity to soy in this population was less than previously estimated.
Le texte complet de cet article est disponible en PDF.Key words : Food protein–induced enterocolitis syndrome, oral challenge, soy allergy, skin prick test
Abbreviations used : CMP, FPIES, IgE-CMA, OFC, SPT
Plan
| Supported by the Israel Dairy Foundation. |
|
| Disclosure of potential conflict of interest: Y. Katz receives research support from the Israel dairy board. The rest of the authors have declared that they have no conflict of interest. |
Vol 127 - N° 3
P. 647 - mars 2011 Retour au numéro
Article précédent
- Sublingual immunotherapy for peanut allergy: Clinical and immunologic evidence of desensitization
- Edwin H. Kim, J. Andrew Bird, Michael Kulis, Susan Laubach, Laurent Pons, Wayne Shreffler, Pamela Steele, Janet Kamilaris, Brian Vickery, A. Wesley Burks
- A randomized controlled study of peanut oral immunotherapy: Clinical desensitization and modulation of the allergic response
- Pooja Varshney, Stacie M. Jones, Amy M. Scurlock, Tamara T. Perry, Alex Kemper, Pamela Steele, Anne Hiegel, Janet Kamilaris, Suzanne Carlisle, Xiaohong Yue, Mike Kulis, Laurent Pons, Brian Vickery, A. Wesley Burks
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?