Cooking influence in tolerance acquisition in egg-induced acute food protein enterocolitis syndrome*

Main Article Content

S. Miceli Sopo
A. Romano
G. Bersani
C. Fantacci
L. Badina
G. Longo
G. Monti
S. Viola
S. Tripodi
G. Barilaro
I.D. Iacono
C. Caffarelli
C. Mastrorilli
S. Barni
F. Mori
L. Liotti
B. Cuomo
F. Franceschini
D. Viggiano
S. Monaco

Keywords

Cooking, Egg, Food protein induced enterocolitis, syndrome, Oral food challenge, Tolerance acquisition

Abstract

Background: Few studies on the age of resolution of Food Protein-Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months.
Objective: We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw.


Methods: We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition.


Results: Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded.


Conclusions: It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.

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References

1. Nowak-Wegrzyn ˛ A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-Workgroup Report of the Adverse Reactions to FooSD Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139, 1111-1126.e4.

2. Sopo SM, Giorgio V, Dello Iacono I, Novembre E, Mori F, Onesimo R. A multicentre retrospective study of 66 Italian children with food protein-induced enterocolitis syndrome: different management for different phenotypes. Clin Exp Allergy. 2012;42:1257-65.

3. Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, Spergel JM. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013;1:343-9.

4. Ludman S, Harmon M, Whiting D, du Toit G. Clinical presentation and referral characteristics of food protein-induced enterocolitis syndrome in the United Kingdom. Ann Allergy Asthma Immunol. 2014;113:290-4.

5. Katz Y, Goldberg MR. Natural history of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14:229-39.

6. Vazquez-Ortiz M, Machinena A, Dominguez O, Alvaro M, Calvo-Campoverde K, Giner MT, et al. Food protein-induced enterocolitis syndrome to fish and egg usually resolves by age 5 years in Spanish children. J Allergy Clin Immunol Pract. 2017;5, 512-515.e1.

7. Lee E, Campbell DE, Barnes EH, Mehr SS. Resolution of acute food protein-induced enterocolitis syndrome in children. J Allergy Clin Immunol Pract. 2017;5, 486-488.e1.

8. Sicherer SH, Eigenmann PA, Sampson HA. Clinical features of food protein-induced enterocolitis syndrome. J Pediatr. 1998;133:214-9.

9. Leonard SA, Nowak-Wegrzyn ˛ A. Clinical diagnosis and management of food protein-induced enterocolitis syndrome. Curr Opin Pediatr. 2012;24:739-45.

10. Miceli Sopo S, Greco M, Monaco S, Tripodi S, Calvani M. Food protein-induced enterocolitis syndrome, from practice to theory. Expert Rev Clin Immunol. 2013;9:707-15.

11. Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134:382-9.

12. Leonard SA, Nowak-Wegrzyn ˛ A. Food protein-induced enterocolitis syndrome. Pediatr Clin North Am. 2015;62: 1463-77.

13. Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123:S365-83.

14. Miceli Sopo S, Greco M, Cuomo B, Bianchi A, Liotti L, Monaco S, et al. Matrix effect on baked egg tolerance in children with IgE-mediated hen’s egg allergy. Pediatr Allergy Immunol. 2016;27:465-70.

15. Hsu P, Mehr S. Egg: a frequent trigger of food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2013;131:241-2.

16. Mehr S, Frith K, Barnes EH, Campbell DE, FPIES STUDY GROUP. Food protein-induced enterocolitis syndrome in Australia: a population-based study 2012-2014. J Allergy Clin Immunol. 2017;140:1323-30.