Paeds Vivas · gastroenterology-hepatology-and-nutrition
Food protein-induced enterocolitis and enteropathy — branching viva
Branching viva from the definition and the 2017 consensus diagnostic criteria of food protein-induced enterocolitis syndrome through the infant with a delayed pallid vomiting collapse, the faltering formula-fed infant with chronic FPIES, the substitute-feed choice, the oral food challenge, and the natural history of tolerance.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a general clinic. The consultant asks you to talk through four children referred with possible food protein-induced enterocolitis syndrome: an infant with a delayed pallid vomiting collapse after rice, a six-week-old with faltering growth on cow's-milk formula, an older child with fish FPIES, and a toddler whose family asks whether the allergy has been outgrown.
Station opening
Examiner: "Define food protein-induced enterocolitis syndrome, and explain how you would tell it apart from sepsis and from IgE-mediated food allergy." [1]
Strong candidate (must-hit)
- Defines FPIES as a non-IgE-mediated, cell-mediated food allergy in which a trigger protein produces delayed repetitive vomiting one to four hours after ingestion with lethargy, pallor and watery diarrhoea, in the absence of classic IgE-mediated skin or respiratory features; separates it from sepsis by the recurring, food-timed, culture-negative pattern and from IgE-mediated allergy by the delay and the absence of urticaria, wheeze and angio-oedema; states that skin-prick tests and specific immunoglobulin E are negative in classic disease. [1]
Weak candidate
- "It is a kind of food allergy, and I would do a skin-prick test to confirm it." [1]
References6ShowHide
- [1]Nowak-Węgrzyn A; Chehade M; Groetch ME; Spergel JM; Wood RA; Allen K International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol, 2017.PMID 28167094
- [2]Sicherer SH; Eigenmann PA; Sampson HA Clinical features of food protein-induced enterocolitis syndrome. J Pediatr, 1998.PMID 9709708
- [4]Caubet JC; Ford LS; Sickles L; Järvinen KM; Sicherer SH; Sampson HA; Nowak-Węgrzyn A Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol, 2014.PMID 24880634
- [6]Leonard SA; Pecora V; Fiocchi AG; Nowak-Węgrzyn A Food protein-induced enterocolitis syndrome: a review of the new guidelines. World Allergy Organ J, 2018.PMID 29441147
- [8]Feuille E; Nowak-Węgrzyn A Medical Algorithms: Recognizing and treating food protein-induced enterocolitis syndrome. Allergy, 2019.PMID 31070799
- [9]Miceli Sopo S; Monaco S; Badina L; Barni S; Toscano A; Tripodi S; Meglio P Food protein-induced enterocolitis syndrome caused by fish and/or shellfish in Italy. Pediatr Allergy Immunol, 2015.PMID 26287446