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Background: The aim of this study was to clarify the clinical characteristics and management of infants with suspected acute food protein–induced enterocolitis syndrome (FPIES) who presented to the pediatric emergency department (ED) before and after the guidelines were published. Methods: This was a retrospective cohort study. We classified the infants as "acute FPIES‐like symptoms" who were younger than 12 months of age and visited the pediatric ED of the National Center for Child Health and Development due to vomiting 1–4 h after food ingestion without any causative disease, such as infection. The medical records of those infants in 2015 and 2021 were reviewed. We used the nonparametric Mann–Whitney U test to compare two groups for continuous variables, whereas chi‐squared or Fisher's exact tests were used for nominal variables. Results: The number of infants with acute FPIES‐like symptoms was 15 (13%) in 2015 and 14 (15%) in 2021. The trigger foods were cow's milk or dairy products in half of the infants, and five as a result of ingestion of hen's eggs in 2021, compared to zero cases in 2015. Five in 2015 and 12 in 2021 required examination at the ED. Three in 2015 and six in 2021 met the diagnostic criteria for acute FPIES in the international consensus guidelines. The emergency physicians did not record at least four minor criteria for acute FPIES in seven in 2015 and five in 2021. No infants (0%) in 2015 and two (14%) in 2021 were referred to the allergy department by an emergency physician. Conclusions: Acute FPIES should be considered one of the differential diagnoses of vomiting, and pediatric medical staff should be aware of FPIES diagnostic criteria and appropriately refer suspected cases to a specialist. [ABSTRACT FROM AUTHOR]

The article presents case study of male infant. in which gastric residual volume of mild of more than 50% from the previous feed persisted without abdominal distension, and loose to watery stool was sometimes observed. It mentions diagnosis of Food protein-induced enterocolitis syndrome; and also mentions focus on the histopathological findings of FPIES, even in surgical cases.

Background: Presently, little is known about the laboratory data several hours after oral food challenge (OFC) in patients with immunoglobulin (Ig)E‐mediated immediate food allergy (FA). Methods: One hundred and twelve subjects who underwent OFC at the present institute between 1 June 2016 and 31 March 2018, were enrolled in this study. Changes in laboratory data several hours after OFC were examined. Results: OFC was positive in 76 patients and negative in 36. Increase in absolute neutrophil count (ANC) was significantly higher in OFC‐positive than in OFC‐negative subjects (median, 2,306/μL vs 637/μL; P < 0.00001). On multivariate regression analysis, a significant correlation was seen between neutrophilia and the development of gastrointestinal symptoms (t = 3.63; P < 0.001). Serum interleukin‐6 increased in 43.8% of the patients with marked neutrophilia and had a significant positive correlation with ANC (r = 0.64; P < 0.001). Serum amylase increased in 33.3% of the OFC‐positive patients and was >100 U/L (median, 642 U/L) in five patients in whom serum lipase also increased markedly (1,197 U/L). There was a significant negative correlation between increase in serum amylase and decrease in absolute eosinophil count (r = −0.36, P < 0.01). Conclusions: Marked neutrophilia was seen after OFC in patients with immediate FA presenting gastrointestinal symptoms, which may provide an insight into the relationship between symptoms and laboratory data. A considerable increase in serum amylase after OFC was also seen in patients with immediate FA, suggesting that the pancreas is a target organ for immediate FA. [ABSTRACT FROM AUTHOR]

Abstract: Background: An increase in absolute neutrophil count (ANC) is seen after oral food challenge test (OFC) in patients with food protein‐induced enterocolitis syndrome (FPIES). Although it has been suggested that interleukin (IL)‐8 is involved in this phenomenon, a possible role for cortisol has not yet been studied. Methods: Six positive OFC in five patients with FPIES due to cows’ milk (CM) proteins, and two negative OFC in two patients with suspected FPIES were analyzed. Absolute neutrophil count, serum IL‐8, and serum cortisol were measured before OFC, 6 and 24 h after the ingestion of CM formula. Results: For the positive OFC, ANC measured 6 h after the ingestion of CM formula was significantly higher than that measured before the OFC (median, 8,761 versus 2,297/μL; P < 0.05). Significant increases in serum cortisol and IL‐8 were observed 6 h after OFC (cortisol, median 1,119 pg/mL before versus 2,141 pg/mL after, P < 0.05; IL‐8, median 15.5 pg/mL before versus 165.3 pg/mL after, P < 0.05). The change ratio (i.e. ratio of that after OFC to that before OFC) of ANC was significantly correlated not only with that of serum IL‐8 (r = 0.90, P < 0.01) but also with that of serum cortisol (r = 0.76, P < 0.05). Moreover, the serum cortisol change ratio was significantly higher in subjects with vomiting than in those without (median, 2.5 versus 1.0, P < 0.05). Conclusions: Serum cortisol, in combination with IL‐8, affects the increase in ANC after OFC. [ABSTRACT FROM AUTHOR]

Background Although serum C-reactive protein ( CRP) and the percentage of eosinophils in peripheral blood (Eo) are increased at onset in infants with food protein-induced enterocolitis syndrome ( FPIES), the relationship of these laboratory findings to prognosis is presently unknown. Methods Correlation of serum CRP and Eo at onset with prognosis was analyzed in 32 patients with FPIES caused by cow's milk ( CM). Results The rate of tolerance acquisition was 18.8%, 56.3%, 87.5%, and 96.9% at the ages of 6, 12, 24, and 36 months, respectively. Serum CRP increased in 50% of subjects at onset (median, 0.21 mg/ dL; range, <0.20-18.2 mg/ dL) and Eo was elevated in 71.9% of subjects at onset (median, 7.1%; range, 1.0-50.5%). Age at tolerance acquisition was significantly positively correlated with serum CRP at onset ( r = 0.45, P < 0.01), and significantly negatively correlated with Eo at onset ( r = −0.36, P < 0.05). Although CM-specific immunoglobulin E antibody ( sIgE) was positive in nine of 32 FPIES patients at onset (median, 0.93; range, 0.38-18.9 kU/L), it decreased thereafter. CM- sIgE at onset did not correlate significantly with prognosis ( r = 0.22, P > 0.05). Conclusions Serum CRP is not only an indicator of the activity of intestinal inflammation, it is also a useful parameter of poor prognosis in FPIES. In contrast, eosinophilia at onset could be used as a marker of good prognosis, suggesting that it has some beneficial effects in the pathophysiology of FPIES. [ABSTRACT FROM AUTHOR]

Background Some infants with food protein-induced enterocolitis syndrome (FPIES) have increased serum C-reactive protein (CRP) and fever in Japan. The aim of this study was therefore to clarify and compare the incidence of this in patients with FPIES versus patients with food protein-induced proctocolitis (FPIP). Methods One hundred and sixteen infants with non-IgE-mediated gastrointestinal food allergies were enrolled in this study and classified into three phenotypes: FPIES presenting with vomiting and/or diarrhea (n = 47); FPIP with bloody stool alone (n =19); and the mixed phenotype (MP), bloody stool with vomiting and/or diarrhea (n = 50). Results Serum CRP was increased in 55.3% of the FPIES group, similar to that in the MP group (54.0%), and significantly higher than in the FPIP group (15.8%; P < 0.01). Fever was observed in 29.8% of the FPIES group, significantly higher than in the MP group (8.0%; P < 0.01) and in the FPIP group (0%; P < 0.05). Patients with fever had significantly higher serum CRP than patients without fever (median, 12.8 vs <0.2 mg/dL, P < 0.00001). Conclusions Serum CRP was significantly higher in the FPIES group than in the FPIP group. This suggests that serum CRP is a useful marker for differentiating the pathogenesis of FPIES from FPIP. From the perspective of serum CRP, the pathology of the intestinal inflammation in MP subjects is suggested to be similar to that of FPIES. [ABSTRACT FROM AUTHOR]

Background: We conducted a multicenter clinical survey to clarify the current attitudes to diagnosis or treatment of neonatal milk allergy (NMA) in institutions providing medical care for high-risk neonates in Japan. Methods: Questionnaires were distributed to 263 institutions that provide medical care for high-risk infants. Information was requested on the number of hospitalized neonates between January 2004 and December 2005, the number of neonates diagnosed with milk allergy, frequent clinical symptoms, and clinical tests performed routinely when NMA was suspected. Results: Responses were received from 145 institutions (55.1%). Of 69 796 hospitalized neonates, a diagnosis of cow's milk allergy was made in 0.21%. The incidence in infants with birthweight <1000 g was 0.35%. Gastrointestinal symptoms were identified as the most frequent symptoms that suggested NMA by 80% of institutions. A challenge test in each suspected case was performed in only 15% of institutions, even though it was considered to be the most significant test for diagnosis. Most institutions considered a specific immunoglobulin E test in cases of suspected NMA, but only one-third agreed on its diagnostic significance. A lymphocyte stimulation test was performed in only 5.5% of institutions. Conclusions: This study is the first to show the incidence of NMA in institutions providing medical care for high-risk neonates in Japan. Current clinical tests may be insufficient for diagnosis of NMA in which non-immunoglobulin-E-mediated delayed allergic reactions are involved. Therefore, awareness of the clinical features of this disorder is required among neonatologists and allergists. [ABSTRACT FROM AUTHOR]

Described herein is the case of an 8-month-old girl with atypical food protein-induced enterocolitis syndrome due to rice. She presented with vomiting and poor general activity 2 h after ingestion of boiled rice. Oral food challenge test using high-pressure retort-processed rice was negative, but re-exposure to boiled rice elicited gastrointestinal symptoms. On western blot analysis the patient's serum was found to contain IgE bound to crude protein extracts from rice seed or boiled rice, but not from retort-processed rice. The major protein bands were not detected in the electrophoresed gel of retort-processed rice extracts, suggesting decomposition by high-temperature and high-pressure processing. Oral food challenge for diagnosing rice allergy should be performed with boiled rice to avoid a false negative. Additionally, some patients with rice allergy might be able to ingest retort-processed rice as a substitute for boiled rice. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 4-year-old boy presented with two episodes of frequent vomiting after consuming one serving of BW noodles at the age of 2 and 3 years. It notes diagnosis of food protein-induced enterocolitis syndrome (FPIES) caused by buckwheat presented in noodles; and mentions that BW could cause FPIES in patients with repeated gastrointestinal symptoms.

A case study of a 6-year-old who vomited for several hours after ingestion of short-neck clam is presented, with a history of similar episodes at one and three years of age, and similar episodes after ingesting squid at the ages of four and five years. The patient was clinically diagnosed with food protein-induced enterocolitis syndrome (FPIES) due to the ingestion of short-neck clam and squid by corresponding symptoms with oral food challenge (OFC) and lymphocyte-stimulation test (LST).

Background Increased C-reactive protein (CRP) and fever are observed in some infants with food protein-induced enterocolitis syndrome (FPIES) in Japan, but the reproducibility of these findings has not yet been confirmed on oral food challenge (OFC). Methods Fourteen infants with FPIES induced by cow's milk (CM) formula were enrolled. OFC using CM formula was performed on each infant once or repeatedly (total 18 tests), with a stepwise incremental protocol in an infection-controlled setting. CRP was measured 24 h after the last ingestion of the CM formula. Results Increased CRP was observed in 11 of the 18 OFC conducted (median, 2.60 mg/dL; range, 0.22-4.84 mg/dL). Fever was induced in six occasions during OFC. Serum CRP in the patients with fever increased to median 3.76 mg/dL (range, <0.7-4.84 mg/dL), which was significantly higher than that of the patients without fever (median <0.1 mg/dL; range, <0.1-2.6 mg/dL; P < 0.001). CRP during OFC significantly correlated with that at disease onset (rs = 0.62, P < 0.02). Three of the four patients with fever at disease onset also had fever during OFC. Conclusions Increased CRP and fever are reproducible during OFC in some infants with FPIES, suggesting that these are not accidental phenomena, but instead are associated with FPIES itself in Japanese patients. [ABSTRACT FROM AUTHOR]