Remission of Acute Food Protein-Induced Enterocolitis Syndrome Confirmed by Oral Food Challenges in Japan
Abstract
:1. Introduction
2. Methods
2.1. Study Design, Setting, and Participants
2.2. Variables and Data Source
2.3. Laboratory Tests
2.4. Skin Prick Test
2.5. Oral Food Challenge Protocol
2.6. Statistical Analysis
3. Results
3.1. Patients and Clinical Features
3.2. OFC Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Major Criterion: |
---|
Vomiting in the 1 to 4 h period following the ingestion of the suspect food and absence of classic IgE-mediated allergic skin or respiratory symptoms. |
Minor criteria: |
1. A second (or more) episode of repetitive vomiting after eating the same suspect food; 2. Repetitive vomiting episode 1–4 h after eating a different food; 3. Extreme lethargy with any suspected reaction; 4. Marked pallor with any suspected reaction; 5. Need for emergency department visit with any suspected reaction; 6. Need for intravenous fluid support with any suspected reaction; 7. Diarrhea in 24 h (usually 5–10 h); 8. Hypotension; 9. Hypothermia. |
All (n = 23) | OFC-Positive (n = 8) | OFC-Negative (n = 15) | p-Value | |
---|---|---|---|---|
Male, no. (%) | 11 (47.8) | 5 (62.5) | 6 (40.0) | 0.555 * |
Age at onset of initial reactions (month), median (IQR †), range | 7.0 (6.25–8.0), 0–15 | 8.0 (6.0–8.25), 0–14 | 7.0 (6.0–7.5), 0–15 | 0.324 ** |
Age at diagnosis (month), median (IQR †) | 8.0 (6.25–11.5) | 11.5 (7.25–17.8) | 7.0 (6.0–9.0) | 0.217 ** |
Causative food, no. (%) | ||||
Soy | 8 (34.8) | 1 (12.5) | 7 (46.7) | 0.136 * |
Egg yolk | 5 (21.7) | 4 (50.0) | 1 (6.7) | |
Milk | 3 (13.0) | 2 (25.0) | 1 (6.7) | |
Wheat | 3 (13.0) | 1 (12.5) | 2 (13.3) | |
Egg white | 2 (8.7) | 0 (0.0) | 2 (13.3) | |
Rice | 1 (4.4) | 0 (0.0) | 1 (6.7) | |
Fish | 1 (4.4) | 0 (0.0) | 1 (6.7) | |
Skin prick test for trigger foods positivity, no. (%) §§ | 0 (0.0) | 0 (0.0) | 0 (0.0) | - |
Specific IgE antibody positivity, no. (%) ‡ | 3 (13.0) | 1 (12.5) | 2 (13.3) | 0.550 * |
Additional allergic conditions, no. (%) | ||||
Atopic dermatitis | 9 (39.1) | 5 (62.5) | 4 (26.7) | 0.221 * |
Asthma | 1 (4.4) | 0 (0.0) | 1 (6.7) | 0.742 * |
Allergic rhinitis | 1 (4.4) | 1 (12.5) | 0 (0.0) | 0.742 * |
IgE-food allergy | 2 (8.7) | 2 (25.0) | 0 (0.0) | 0.213 * |
Birth history of cesarean section, no. (%) | 11 (47.8) | 5 (62.5) | 6 (40.0) | 0.551 * |
Birth weight (g) § | 2963 ± 429 | 2956 ± 575 | 2996 ± 413 | 0.560 ** |
Breastfeeding at onset, no. (%) | 17 (73.9) | 6 (75.0) | 11 (73.3) | 0.681 * |
Family allergic disease history, no. (%) | 15 (65.2) | 5 (62.5) | 10 (66.7) | 0.795 * |
Bodyweight at OFC (kg) ‡ | 11.1 ± 2.7 | 11.3 ± 2.95 | 10.8 ± 2.54 | 0.557 *** |
White blood cell (/μL) § | 9631 ± 3290 | 8076 ± 1670 | 10,306 ± 3656 | 0.158 *** |
Neutrophil (%) § | 31.8 ± 11.8 | 36.9 ± 9.97 | 29.5 ± 12.2 | 0.086 *** |
Eosinophil (%) § | 2.80 ± 2.32 | 3.06 ± 2.82 | 2.69 ± 2.07 | 0.574 *** |
CRP (mg/dL) § | 2.80 ± 2.32 | 1.25 ± 2.09 | 0.30 ± 0.91 | 0.297 *** |
Total IgE (IU/mL) § | 80.9 ± 170 | 52.6 ± 62.3 | 94.8 ± 201 | 0.519 *** |
Specific IgE antibody (UA/mL) § | 0.170 ± 0.194 | 0.14 ± 0.01 | 0.18 ± 0.23 | 0.543 *** |
TARC (pg/mL) § | 718 ± 581 | 961 ± 857 | 589 ± 335 | 0.314 *** |
Age in months OFC performed, median (IQR †), range | 21.0 (15.3–32.0), 6–56 | 23.5 (15.5–33.3), 7–56 | 19.0 (14.5–31.5), 6–45 | 0.722 ** |
Duration between onset and OFC (months) | 14 (8–24) | 14 (7.75–20.75) | 13 (8.5–23.5) | 0.897 ** |
Patient No. | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
---|---|---|---|---|---|---|---|---|
Sex | Female | Male | Male | Male | Male | Female | Female | Male |
Food | Milk | Milk | Egg yolk | Egg yolk | Egg yolk | Wheat | Egg yolk | Soy |
Initial diagnosis | Acute FPIES | Acute FPIES or FPIAP | Acute FPIES | Acute FPIES | Acute FPIES | Acute FPIES | Acute FPIES | Acute FPIES |
Age at onset (m) | 0 | 0 | 9 | 8 | 14 | 8 | 8 | 8 |
Age at diagnosis(m) | 1 | 0 | 16 | 13 | 26 | 10 | 15 | 8 |
Age at OFC (m) | 7 | 14 | 56 | 25 | 32 | 22 | 37 | 16 |
First reaction of acute FPIES (times) | Vomiting (2) | Bloody stool Vomiting (2) | Vomiting (3) Diarrhea (2) | Vomiting (10) | Vomiting (frequent) | Vomiting (5) Diarrhea (1) | Vomiting (2) Lethargy | Vomiting (4) Diarrhea (1) |
Time (h) | 3–5 | Unknown | 2 | 3 | 2 | 5 | 2 | 4 |
Severity in the first reaction | Mild | Mild | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate |
OFC reaction (times) | Vomiting (4) | Vomiting (3) | Vomiting (2) Diarrhea (1) Abdominal pain | Vomiting (4) | Vomiting (3) Abdominal pain Lethargy | Vomiting (3) | Vomiting (2) Lethargy | Vomiting (1) Lethargy |
Time (h) | 2.5 | 8 | 2 | 2.5 | 2 | 2 | 3 | 5 |
Day (day) | 1 | 2 | 1 | 1 | 1 | 4 | 1 | 1 |
Food protein of body weight at the reaction (g/kg) | 0.008 | 0.03 | 0.006 | 0.007 | 0.006 | 0.3 | 0.007 | 0.006 |
Severity in OFC | Moderate | Moderate | Mild | Moderate | Moderate | Moderate | Moderate | Mild |
Treatment | Intravenous normal saline bolus | Intravenous normal saline bolus | None | Intravenous normal saline bolus and corticosteroids | None | Intravenous normal saline bolus and corticosteroids | Intravenous normal saline bolus | None |
Confirmatory diagnosis by OFC | Acute FPIES | Unclassifiable † | Acute FPIES | Acute FPIES | Acute FPIES | Acute FPIES | Acute FPIES | Acute FPIES |
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Nishimura, K.; Yamamoto-Hanada, K.; Sato, M.; Toyokuni, K.; Ogita, H.; Kiguchi, T.; Miyagi, Y.; Inuzuka, Y.; Saito-Abe, M.; Irahara, M.; et al. Remission of Acute Food Protein-Induced Enterocolitis Syndrome Confirmed by Oral Food Challenges in Japan. Nutrients 2022, 14, 4158. https://doi.org/10.3390/nu14194158
Nishimura K, Yamamoto-Hanada K, Sato M, Toyokuni K, Ogita H, Kiguchi T, Miyagi Y, Inuzuka Y, Saito-Abe M, Irahara M, et al. Remission of Acute Food Protein-Induced Enterocolitis Syndrome Confirmed by Oral Food Challenges in Japan. Nutrients. 2022; 14(19):4158. https://doi.org/10.3390/nu14194158
Chicago/Turabian StyleNishimura, Koji, Kiwako Yamamoto-Hanada, Miori Sato, Kenji Toyokuni, Hiroya Ogita, Tomoyuki Kiguchi, Yoshitsune Miyagi, Yusuke Inuzuka, Mayako Saito-Abe, Makoto Irahara, and et al. 2022. "Remission of Acute Food Protein-Induced Enterocolitis Syndrome Confirmed by Oral Food Challenges in Japan" Nutrients 14, no. 19: 4158. https://doi.org/10.3390/nu14194158