Management of acute food protein-induced enterocolitis syndrome emergencies at home and in a medical facility |
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| Authors: | Stephanie A. Leonard Stefano Miceli Sopo Mary Grace Baker Alessandro Fiocchi Robert A. Wood Anna Nowak-Węgrzyn |
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| Affiliation: | 1. Division of Pediatric Allergy & Immunology, Department of Pediatrics, University of California San Diego, Rady Children’s Hospital, San Diego, California;2. Pediatric Allergy Unit, Pediatrics Area, Department of Life Sciences and Public Health, Policlinico Gemelli University Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy;3. Division of Pediatric Allergy & Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York;4. Istituto Di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Childrens'' Hospital, Rome, Italy;5. Pediatric Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children’s Hospital, New York, New York;1. Center for Food Allergy, Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York;2. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut;3. Section of Rheumatology, Allergy, and Immunology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut;1. Reinier de Graaf Gasthuis, Department of Pediatric Allergology, Delft, The Netherlands;2. Erasmus MC University Medical Center, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Rotterdam, The Netherlands;1. Division of Pediatric Allergy & Immunology, Rady Children’s Hospital San Diego, University of California, San Diego, 3020 Children’s Way, MC 5114, San Diego, CA 92123, USA;2. Division of Pediatric Allergy, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Box 1198, One Gustave L. Levy Place, New York, NY 10029, USA;1. Department of Pediatrics, University of Texas Southwestern, Dallas, Texas;2. Children’s Hospital of Philadelphia, University of Pennsylvania Medical School, Philadelphia, Pa;3. Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children’s Hospital, New York, NY;4. Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland;1. Division of Pediatrics, Department of Pediatric Cardiology and Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile;2. Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile;1. Allergy and Immunology, Department of Pediatrics, Hassenfeld Children’s Hospital, New York University School of Medicine, New York, New York;2. Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland;3. Children’s Hospital of Philadelphia, University of Pennsylvania Medical School, Philadelphia, Pennsylvania;4. Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas;6. Bambino Gesù Childrens'' Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy;5. Pediatric Allergy Unit, Department of the Child and Adolescent, Geneva University Hospital, Geneva, Switzerland |
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| Abstract: | ObjectiveAcute food protein-induced enterocolitis syndrome (FPIES) is characterized by delayed repetitive vomiting after ingestion of a trigger food, and severe reactions may lead to dehydration, hypotension, and shock. We provide recommendations on management of FPIES emergencies in a medical facility and at home.Data SourcesThis review summarizes the literature on clinical context, pathophysiology, presentation, and treatment of FPIES emergencies.Study SelectionsWe referred to the 2017 International Consensus Guidelines for the Diagnosis and Management of FPIES and performed a literature search identifying relevant recent primary articles and review articles on clinical management.ResultsManagement of FPIES emergencies in a medical facility is based on severity of symptoms and involves rehydration, ondansetron, and corticosteroids. A proactive approach for reactions occurring at home involves prescribing oral ondansetron and providing an individualized treatment plan based on the evolution of symptoms and severity of past reactions. A better understanding of the pathophysiology of FPIES and randomized trials on ondansedron and cocorticosteroid use could lead to more targeted treatments.ConclusionChildren with FPIES are at risk for severe symptoms constituting a medical emergency. Management of FPIES emergencies is largely supportive, with treatment tailored to the symptoms, severity of the patient’s condition, location of reaction, and reaction history. |
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