Γαστρεντερική αλλεργία από την πρωτεϊνη των τροφών στα παιδιά.

Οι τροφικές αλλεργίες ταξινομούνται ανάλογα με την ανοσοπαθογένεια και την κλινική τους εικόνα σε τροφικές αλλεργίες οι οποίες μεσολαβούνται από ειδική ανοσοσφαιρίνη Ε (IgE) , τροφικές αλλεργίες οι οποίες μεσολαβούνται από έναν συνδυασμό ΙgE μεσολαβούμενης και κυτταρικής ανοσολογικής αντίδρασης, και τροφικές αλλεργίες οι οποίες μεσολαβούνται αποκλειστικά από κυτταρικούς ανοσολογικούς μηχανισμούς χωρίς την συμμετοχή ειδικής ανοσοσφαιρίνης Ε.

Στις δύο τελευταίες περιπτώσεις οι ασθενείς παρουσιάζουν συμπτώματα από το πεπτικό σύστημα τα οποία μπορεί να εμφανισθούν ακόμη και ώρες μετά την κατανάλωση της υπεύθυνης τροφής. Σε αυτήν την κατηγορία ανήκουν κλινικές οντότητες όπως το σύνδρομο της επαγόμενης από την πρωτεϊνη των τροφών εντεροκολίτιδας (FPIES), η επαγόμενη από την πρωτεϊνη των τροφών αλλεργική πρωκτοκολίτιδα (FPIP), οι επαγόμενες από την πρωτεϊνη των τροφών εντεροπάθειες (Enteropathy)  και οι ηωσινοφιλικές παθήσεις του γαστρεντερικού συστήματος (EGID).

Η ομάδα των Morita  H, Nomura  I, Matsuda  A, Saito  H, Matsumoto  K. από το πανεπιστήμιο του Τόκιο της Ιαπωνίας, παρουσιάζουν σε ένα πρόσφατο άρθρο ανασκόπησης την εμπειρία τους σχετικά με τους παθογενετικούς μηχανισμούς και τις κλινικές εικόνες της  γαστρεντερικής αλλεργίας από την πρωτεϊνη των τροφών στα παιδιά.

Με αφορμή το άρθρο αυτό επισημαίνονται παρακάτω άρθρα ανασκόπησης με το ίδιο θέμα, τα οποία δημοσιεύθηκαν στο διάστημα Ιουλίου-Αυγούστου 2013.

 

Morita H, Nomura I, Matsuda A, Saito H, Matsumoto K.

Gastrointestinal food allergy in infants.

Allergol Int. 2013 Sep;62(3):297-307.

Abstract

Food allergies are classified into three types, “IgE-mediated,” “combined IgE- and cell-mediated” and “cell-mediated/non-IgE-mediated,” depending on the involvement of IgE in their pathogenesis. Patients who develop predominantly cutaneous and/or respiratory symptoms belong to the IgE-mediated food allergy type. On the other hand, patients with gastrointestinal food allergy (GI allergy) usually develop gastrointestinal symptoms several hours after ingestion of offending foods; they belong to the cell-mediated/non-IgE-mediated or combined IgE- and cell-mediated food allergy types. GI allergies are also classified into a number of different clinical entities: food protein-induced enterocolitis syndrome (FPIES), food protein-induced proctocolitis (FPIP), food protein-induced enteropathy (Enteropathy) and eosinophilic gastrointestinal disorders (EGID). In the case of IgE-mediated food allergy, the diagnostic approaches and pathogenic mechanisms are well characterized. In contrast, the diagnostic approaches and pathogenic mechanisms of GI allergy remain mostly unclear. In this review, we summarized each type of GI allergy in regard to its historical background and updated clinical features, offending foods, etiology, diagnosis, examinations, treatment and pathogenesis. There are still many problems, especially in regard to the diagnostic approaches for GI allergy, that are closely associated with the definition of each disease. In addition, there are a number of unresolved issues regarding the pathogenic mechanisms of GI allergy that need further study and elucidation. Therefore, we discussed some of the diagnostic and research issues for GI allergy that need further investigation.

Η πρόσβαση στο πλήρες κείμενο της ανασκόπησης είναι ελεύθερη από την ιστοσελίδα του εκδότη:

http://ai.jsaweb.jp/fulltext/062030297/062030297_index.html

 

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 Aug;9(8):707-15.

Abstract

Food protein-induced enterocolitis syndrome (FPIES) is an allergic disease, probably non-IgE-mediated, with expression predominantly in the GI tract. The most characteristic symptom is repeated, debilitating vomiting. It occurs 2-6 h after ingestion of culprit food and is usually accompanied by pallor and lethargy. There may be diarrhea, and in 10-20% of cases, severe hypotension. These symptoms resolve completely within a few hours. The food most frequently involved is cow’s milk, followed by rice, but many other foods may be involved. The prognosis is generally good in a few years. In this review the authors try to cope, with the help of some case histories, with the practical clinical aspects of FPIES. The authors also try to provide a management approach based on current knowledge, and finally, to point out the aspects of FPIES that are still controversial.

http://www.expert-reviews.com/doi/abs/10.1586/1744666X.2013.814418

Η πρόσβαση στο άρθρο προαπαιτεί συνδρομή.

 

Kirsi M. Järvinen, Anna Nowak-Węgrzyn.

Food Protein-Induced Enterocolitis Syndrome (FPIES): Current Management Strategies and Review of the Literature.

The Journal of Allergy and Clinical Immunology: In Practice – July 2013, 317-322.e4.

Abstract.

Food protein-induced enterocolitis syndrome (FPIES) is a non–IgE-mediated gastrointestinal food hypersensitivity that manifests as profuse, repetitive vomiting, often with diarrhea, leading to acute dehydration and lethargy or weight loss and failure to thrive if chronic. FPIES is elicited most commonly by milk and soy proteins; however, rice, oat, and other solid foods may also elicit FPIES. Certain FPIES features overlap with food protein-induced enteropathy and proctocolitis, whereas others overlap with anaphylaxis. FPIES is not well recognized among pediatricians and emergency department physicians; the affected children are often mismanaged as having acute viral gastrointestinal illness, sepsis, or surgical disease, delaying diagnosis of FPIES for many months. The aim of this review is to provide case-driven presentation of the features of FPIES. Although randomized clinical trials on management options are missing, the relevant current literature and authors’ experience are reviewed in detail.

http://www.jaci-inpractice.org/article/S2213-2198%2813%2900200-6/abstract

Η πρόσβαση στο άρθρο προαπαιτεί συνδρομή.

 

Marion Groetch, Michelle Henry, Mary Beth Feuling, Jennifer Kim.

Guidance for the Nutrition Management of Gastrointestinal Allergy in Pediatrics.

Journal of Allergy and Clinical Immunology: In Practice- July 2013, 323-331.

Abstract.

Food allergies and their related elimination diets have been associated with an increased risk of inadequate nutrient intake and poor growth in the pediatric population. In recognition of these nutritional risks, the National Institute of Allergy and Infectious Diseases Guidelines for the Diagnosis and Management of Food Allergy in the United States recommend nutrition counseling and close growth monitoring for all children with food allergy. The care of children with gastrointestinal food allergic disorders can be complicated and is best performed with a structured approach in which medical and nutrition needs are addressed simultaneously. Children with gastrointestinal food allergy may be at greater nutritional risk because of decreased dietary intake. For these children, it is important to perform a comprehensive nutrition assessment to identify nutrition-related problems and to develop and implement a plan that meets the patient’s needs within the context of the elimination diet. We provide an overview of the nutritional risks and strategies to assess nutritional status in pediatric patients with gastrointestinal food allergy.

http://www.jaci-inpractice.org/article/S2213-2198%2813%2900224-9/abstract

Η πρόσβαση στο άρθρο προαπαιτεί συνδρομή.