References of Food Allergy and Enterocolitis syndrome

Food protein–induced enterocolitis syndrome (FPIES) is an uncommon non–IgE-mediated gastrointestinal food hypersensitivity of infancy with an incidence reportedly increasing.

Symptoms include profuse vomiting and diarrhea arising within 1 to 3 hours after ingestion of the causative food and may lead to dehydration, hypotension, and shock. Hypothermia, pallor, and lethargy are other common features; laboratory tests usually show neutrophilia, thrombocytosis, and metabolic acidosis. FPIES caused by Cow’s milk, soy-based formulas and solid foods has also been described.

Enterocolitis induced in infants by cow’s milk and/or soy protein has been recognized for decades. Symptoms typically begin in the first month of life in association with failure to thrive and may progress to acidemia and shock. Symptoms resolve after the causal protein is removed from the diet but recur with a characteristic symptom pattern on re-exposure. Approximately 2 hours after reintroduction of the protein, vomiting ensues, followed by an elevation of the peripheral blood polymorphonuclear leukocyte count, diarrhea, and possibly lethargy and hypotension. The disorder is generally not associated with detectable food-specific IgE antibody. There are increasing reports of additional causal foods, prolonged clinical courses, and onset outside of early infancy, leading to description of a food protein-induced enterocolitis syndrome. The disorder poses numerous diagnostic and therapeutic challenges.

References of Food Allergy and Enterocolitis syndrome

Monti G, Castagno E, Liguori SA, Lupica MM, Tarasco V, Viola S, et al. Food protein–induced enterocolitis syndrome by cow’s milk proteins passed through breast milk. J Allergy Clin Immunol. 2011;127:679–680

Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111:829–835

Franke AA, Halm BM, Custer LJ, Tatsumura Y, Hebshi S. Isoflavones in breastfed infants after mothers consume soy. Am J Clin Nutr. 2006;84:406–413

Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123:e459–e464

Vadas P, Wai Y, Burks W, Perelman B. Detection of peanut allergens in breast milk of lactating women. JAMA. 2001;285:1746–1748

Nowak-Wegrzyn A, Muraro A. Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2009;9:371–377

Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. 2005;115:149–156

Powell GK. Milk- and soy-induced enterocolitis of infancy. J Pediatr. 1978;93:553–560

Powell GK. Enterocolitis in low-birth-weight infants associated with milk and soy protein intolerance. J Pediatr. 1976;88:840–844

Powell G. Food protein-induced enterocolitis of infancy: differential diagnosis and management. Compr Ther. 1986;12:28–37

Halpin TC, Byrne WJ, Ament ME. Colitis, persistent diarrhea, and soy protein intolerance. J Pediatr. 1977;91:404–407

Busse P, Sampson HA, Sicherer SH. Non-resolution of infantile food protein-induced enterocolitis syndrome (FPIES). [abstract] J Allergy Clin Immunol. 2000;105:S129

Sicherer SH, Eigenmann PA, Sampson HA. Clinical features of food protein-induced enterocolitis syndrome. J Pediatr. 1998;133:214–219

Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111:829–835

Levy Y, Danon YL. Food protein-induced enterocolitis syndrome—not only due to cow’s milk and soy. Pediatr Allergy Immunol. 2003;14:325–329
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Rubin M. Allergic intestinal bleeding in the newborn. Am J Med Sci. 1940;200:385–387

Gryboski J. Gastrointestinal milk allergy in infancy. Pediatrics. 1967;40:354–362
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Fontaine J, Navarro J. Small intestinal biopsy in cow’s milk protein allergy in infancy. Arch Dis Child. 1975;50:357–362

Hill DJ, Firer MA, Shelton MJ, Hosking CS. Manifestations of milk allergy in infancy: clinical and immunological findings. J Pediatr. 1986;109:270–276

Vandenplas Y, Edelman R, Sacre L. Chicken-induced anaphylactoid reaction and colitis. J Pediatr Gastroen Nutri. 1994;19:240–241
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Vitoria JC, Camarero C, Sojo A, Ruiz A, Rodriguez-Soriano T. Enteropathy related to fish, rice and chicken. Arch Dis Child. 1982;57:44–48

Burks AW, Casteel HB, Fiedorek SC, Williams LW, Pumphrey CL. Prospective oral food challenge study of two soybean protein isolates in patients with possible milk or soy protein enterocolitis. Pediatr Allergy Immunol. 1994;5:40–45

Murray K, Christie D. Dietary protein intolerance in infants with transient methemoglobinemia and diarrhea. J Pediatr. 1993;122:90–92

Chung HL, Hwang JB, Park JJ, Kim SG. Expression of transforming growth factor beta1, transforming growth factor type I and II receptors, and TNF-alpha in the mucosa of the small intestine in infants with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2002;109:150–154

Lin XP, Magnusson J, Ahlstedt S, Dahlman-Hoglund A, Hanson LL, Magnusson O, et al. Local allergic reaction in food-hypersensitive adults despite a lack of systemic food-specific IgE. J Allergy Clin Immunol. 2002;109:879–887

Goldman H, Provjanksy R. Allergic proctitis and gastroenteritis in children. Am J Surg Pathol. 1986;10:75–86
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Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT. Food allergy: the major cause of infantile colitis. Arch Dis Child. 1984;59:326–329

Coello-Ranurez P, Larrosa-Haro A. Gastrointestinal occult hemorrhage and gastroduodenitis in cow’s milk protein intolerance. J Pediatr Gastroenterol Nutri. 1984;3:215–218

Van Sickle GJ, Powell GK, McDonald PJ, Goldblum RM. Milk- and soy protein- induced enterocolitis: evidence for lymphocyte sensitization to specific food proteins. Gastroenterology. 1985;88:1915–1921

Hoffman KM, Ho DG, Sampson HA. Evaluation of the usefulness of lymphocyte proliferation assays in the diagnosis of allergy to cow’s milk. J Allergy Clin Immunol. 1997;99:360–366

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McDonald PJ, Goldblum RM, Van Sickle GJ, Powell GK. Food protein-induced enterocolitis: altered antibody response to ingested antigen. Pediatr Res. 1984;18:751–755

Heyman M, Darmon N, Dupont C, Dugas B, Hirribaren A, Blaton MA, et al. Mononuclear cells from infants allergic to cow’s milk secrete tumor necrosis factor alpha, altering intestinal function. Gastroenterology. 1994;106:1514–1523

Kapel N, Matarazzo P, Haouchine D, Abiola N, Guerin S, Magne D, et al. Fecal tumor necrosis factor alpha, eosinophil cationic protein and IgE levels in infants with cow’s milk allergy and gastrointestinal manifestations. Clin Chem Lab Med. 1999;37:29–32

Majamaa H, Aittoniemi J, Miettinen A. Increased concentration of fecal alpha1-antitrypsin is associated with cow’s milk allergy in infants with atopic eczema. Clin Exp Allergy. 2001;31:590–592

Benlounes N, Dupont C, Candalh C, Blaton M-A, Darmon N, Desjeux J-F, et al. The threshold for immune cell reactivity to milk antigens decreases in cow’s milk allergy with intestinal symptoms. J Allergy Clin Immunol. 1996;98:781–789

Benlounes N, Candalh C, Matarazzo P, Dupont C, Heyman M. The time-course of milk antigen-induced TNF-alpha secretion differs according to the clinical symptoms in children with cow’s milk allergy. J Allergy Clin Immunol. 1999;104:863–869

Planchon S, Fiocchi C, Takafuji V, Roche JK. Transforming growth factor-beta1 preserves epithelial barrier function: identification of receptors, biochemical intermediates, and cytokine antagonists. J Cell Physiol. 1999;181:55–66

Planchon S, Martins C, Guerrant R, Roche J. Regulation of intestinal epithelial barrier function by TGF-beta 1. J Immunol. 1994;153:5730–5739

Sampson HA, Anderson JA. Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr. 2000;30(suppl):S87–S94

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Clinical and Editor in Chief :

Dr Widodo Judarwanto, pediatrician email :, Curiculum Vitae

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