Journal of food allergy最新文献

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated hypersensitivity reaction known to be triggered by a variety of foods. We present a rare case of a 10-year-old boy with no history of atopy who experienced multiple episodes of delayed, profuse vomiting and lethargy following mushroom ingestion, beginning in infancy. Diagnosis of acute FPIES was confirmed through an oral food challenge, with negative serum IgE and skin prick testing supporting a non-IgE-mediated mechanism. This case represents only the second reported instance of mushroom-induced FPIES in the pediatric population. Given the distinct biological properties of fungi and their increasing use as alternative protein sources, mushrooms may represent an emerging and underrecognized trigger of FPIES, warranting increased clinical awareness.

Background: The impact of food protein-induced enterocolitis syndrome (FPIES) extends beyond the direct effects after consumption of an inciting food. Although elimination of the trigger food does alleviate the symptoms of FPIES, it does not address the burden of disease among patients and families living with FPIES. When managing FPIES, consideration should be taken with regard to the potential impact and complications attributed to food avoidance.

Objective: The objective was to review the epidemiology of FPIES and discuss the associated complications of FPIES, such as nutritional deficiencies, food aversions, financial burden, and overall effect on quality of life of patients and families with FPIES.

Methods: A literature review was conducted through the aid of the University of Southern California Norris Medical Library services. Only peer-reviewed sources were used.

Results: The incidence of FPIES ranges from 0.0041 to 0.7%. When compared with individuals with immunoglobulin E (IgE) meditated food allergies, caregivers of children with FPIES reported poor quality of life and increased feeding difficulties. Individuals with multiple trigger foods are more likely to develop food aversion compared with individuals with one food trigger. Failure to thrive, poor weight gain, and nutritional deficiencies can be seen because of food restriction in patients with FPIES and do not just represent presenting symptoms of FPIES.

Conclusion: There was poorer quality of life and increased psychosocial burden among individuals with FPIES and caregivers of individuals with FPIES. Given the associated complications of nutritional deficiency, feeding difficulties, food aversion, and psychosocial stress, FPIES management should involve a multidisciplinary approach that involves nutrition, speech therapy, occupational therapy, and/or mental health services. Further research and data are needed to assess the financial burden of disease on individuals and families affected by FPIES and the long-term impact that FPIES may have on the growth and nutrition.

Food protein-induced allergic proctocolitis (FPIAP) is a condition that causes rectal bleeding and mucous in stools, which typically presents in healthy infants within the first month of life and improves by 12 months of age. It can present in both breast- and formula-fed infants, with the most common implicated foods being cow's milk and soy protein. Currently, there are no widely accepted diagnostic criteria, but it is considered a clinical diagnosis, with FPIAP symptoms resolving with removal of culprit food(s) and recurrence with food reintroduction. Although the duration of the elimination diet is not well studied, most current guidelines suggest rechallenging with the suspected food after 2-4 weeks because some patients will have spontaneous resolution. Recent studies have shown an increase in the development of immunoglobulin E-mediated food allergies in children with FPIAP, possibly due to prolonged avoidance of the culprit food, which has led to experts debating the risks and benefits of early food reintroduction in FPIAP. This review summarizes our current understanding of the condition and postulates additional mechanistic and outcome investigations needed to better understand the underlying pathophysiology of the condition and the long-term consequences of elimination diets.

Background: Eosinophilic esophagitis (EoE) is an increasingly common allergic and gastrointestinal condition affecting both children and adults. The objective of this review was to summarize the existing literature on the impact of EoE on quality of life, physical well-being, psychosocial functioning, and healthcare utilization.

Methods: Literature searches were performed using PubMed. Keyword combinations included those representing eosinophilic esophagitis and quality of life (QOL), anxiety, depression, sleep disturbance, financial impact, and healthcare utilization.

Results: EoE impacts multiple facets of patients' lives, and this does not always correlate with endoscopic and histologic findings. QOL appears to be significantly associated with symptom burden, which can be influenced by symptom-specific anxiety and esophageal hypervigiliance. Patients with EoE also have increased health-care costs, which are primarily due to provider visits, diagnostic procedures, medications, disease complications, and "hidden costs."

Conclusion: Providers caring for patients with EoE should be aware of the complex interplay between the emotional, mental, social, and financial impacts of this disease and consider them carefully during shared decision-making.

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus in which allergic, gastrointestinal, and psychiatric comorbidities are common. As such, multidisciplinary approaches to EoE management may provide an opportunity to centralize EoE care and ensure that all aspects of the patient's condition and comorbidities are being managed in a comprehensive, unified approach to optimize patient outcomes. This collaborative approach has been shown to improve the likelihood of clinical and histologic remission in patients with EoE.¹ Allergists, gastroenterologists, registered dietitians, and mental health providers all bring unique skills and expertise needed to improve the care of patients with EoE. In this article, we discuss the individual roles of each team member at the Dallas Eosinophilic GI Disease and Esophagitis Program at Children's Health in Dallas, Texas, and how they work together to provide comprehensive care to patients with EoE.

Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E mediated food hypersensitivity disorder that primarily affects children in the first few years of life but may affect all ages. An FPIES diagnosis remains challenging due to the lack of specific biomarkers and is typically based on the clinical history and oral food challenges (OFC).

Methods: This review examines the current literature on diagnosing primarily pediatric FPIES, indications and timing for OFCs, specific considerations for adult and atypical FPIES OFCs, management of co-reactive or cross-reactive foods, and factors that influence the location and approach for conducting OFCs.

Results: An FPIES diagnosis includes meeting specific clinical criteria, with OFCs being the diagnostic standard in cases of diagnostic uncertainty. In the United States, OFCs are generally performed 12 to 18 months after the last reaction to a suspected trigger to assess for tolerance. Regional variations in trigger food prevalence and OFC timing were noted. Nutritional and cultural importance of the offending food, severity of previous reactions, and parental comfort are factors in deciding the timing and setting of OFCs. Management of potential co-reactive and cross-reactive foods remains variable, requiring cautious, supervised reintroduction.

Conclusion: FPIES requires a careful diagnosis and management. OFC timing and approach should be tailored to individual patient needs and factor in past reaction severity and the importance of the food trigger in the regional diet and nutritional value. More research is needed to standardize OFC protocols. Enhanced guidelines and increased awareness among health-care providers can lead to more accurate diagnoses and better FPIES management, ultimately improving patient outcomes.

Background: Parents are primary caregivers for young children with food allergy. Although food allergy-related caregiver stress is well documented, little is known about caregivers' daily food allergy management behaviors such as identifying safe foods and epinephrine availability.

Objective: This study characterized caregivers' daily food allergy management behaviors and identified potential areas of food allergy education and intervention.

Methods: Eighty-three primary caregivers (91% women) of young children (mean ± standard deviation age 3.16 ± 1.33 years; 37% girls, 65% White), diagnosed with an immunoglobulin E-mediated food allergy, were recruited from pediatric food allergy clinics. Participants completed two separate food allergy management 24-hour recall-caregiver interviews. Summary statistics were calculated to characterize overall caregiver food allergy management behaviors with regard to their young children's snacks and meals.

Results: The majority of meals and/or snacks were eaten at home (64.4%) or daycare and/or school (23.4%). Adults observed 99.4% of meals and/or snacks (70.1% by parents). Epinephrine autoinjectors were available for 95.8% of meals and/or snacks, usually in a nearby room (82.1%). Most foods and/or beverages (87.8%) were prepared at home and, for most (98.2%), the caregiver did not take a specific action that day to ensure the food was allergen-free, but some caregivers checked the ingredients on an earlier date (21.3%) or on the general product (30.3%).

Conclusion: Analysis of results indicated frequent epinephrine availability but infrequent use of behaviors that verify foods as allergen-free when the food is ingested, which may place children at risk of allergic reactions and indicates a need for clinician education on food safety decision-making. The findings highlight the need for support for primary caregivers, who are preparing the majority of children's meals and/or snacks, and education and/or policy for daycare and/or schools where many meals are ingested.

Background: Peanut allergy remains a common problem that persists into adulthood for most patients, with risks of accidental ingestion and poor quality of life. Oral immunotherapy (OIT) and anti-immunoglobulin E (IgE) therapy are effective options for peanut allergy; however, each therapy has limitations, which makes them not ideal for all patients.

Objective: The objective was to summarize recent studies that support sublingual immunotherapy (SLIT) for peanut allergy as an alternative option to OIT and anti-IgE therapy, and to discuss practical considerations for its use in clinical practice.

Methods: Published reports of SLIT for the treatment of peanut allergy from the past 15 years were identified. Efficacy as measured by food challenges was compared across studies as well as dosing reactions during SLIT therapy.

Results: Published studies of peanut SLIT demonstrate significant increases in reaction threshold after therapy. When considering desensitization, higher thresholds were reported with younger age at initiating therapy. Furthermore, the potential for a 3-month remission was seen for toddlers after treatment. Adverse effects with SLIT were similar across the ages, with transient oropharyngeal pruritus being most commonly reported. Severe symptoms that require treatment with epinephrine have generally not been reported. Despite the reassuring safety, withdrawal from therapy was common in older participants. Key questions remain with regard to the minimum duration of sublingual administration, optimal maintenance dose, and best measures of treatment efficacy.

Conclusion: Peanut SLIT has been extensively studied, which demonstrated desensitization at levels that approach OIT while also having a simple administration and reassuring safety that may make it a good option for peanut allergy alongside OIT and anti-IgE therapy.