An infantile case of severe acute FPIES (Food protein-induced enterocolitis syndrome) caused by cow's milk with sudden loss of consciousness and acidosis at diagnostic oral food challenge

DOI Web Site 12 References
  • Hamaguchi Sayaka
    Department of Pediatrics, Tokyo Metropolitan Hiroo Hospital Allergy Center, National Center for Child Health and Development
  • Yamamoto-Hanada Kiwako
    Allergy Center, National Center for Child Health and Development
  • Sato Miori
    Allergy Center, National Center for Child Health and Development
  • Oomi Natsuki
    Department of Pediatrics, Tokyo Metropolitan Hiroo Hospital
  • Kumamoto Mariko
    Department of Pediatrics, Tokyo Metropolitan Hiroo Hospital
  • Ogawa Erika
    Department of Pediatrics, Tokyo Metropolitan Hiroo Hospital
  • Nomura Ichiro
    Allergy Center, National Center for Child Health and Development
  • Yamamoto Yasuhito
    Department of Pediatrics, Tokyo Metropolitan Hiroo Hospital

Bibliographic Information

Other Title
  • 生後3か月時に軽症で発症し，食物経口負荷試験にて急激な意識障害とアシドーシスを伴う重症症状を呈した乳によるacute FPIES（Food protein-induced enterocolitis syndrome）の1例

Abstract

<p>Acute food protein-induced enterocolitis (acute FPIES) -related oral food challenges (OFC) have not been systematically studied; high-quality studies providing insight into the relationship between various conditions (i. e, dosing regimen, severity of previous symptoms, loading dose) and the severity of symptoms induced by OFC are lacking; and even in the international consensus guideline of FPIES, the methodology is not fully established. We report a case of a 3-month-old boy. The infant was asymptomatic on mixed feeding until 1 month of age but developed symptoms suggestive of mild acute FPIES upon ingestion of plain milk at 3 months of age. We performed OFC to confirm the diagnosis using loading dose according to the international consensus guidelines but severe symptoms including loss of consciousness and acidosis appeared. FPIES-related OFCs in infants should be conducted with caution, especially when the time is short from the last episode. Given the potential for severe reactions, preparation for emergent situation is needed even when performed using guideline dosage regimen. The methodology for FPIES-related OFCs is yet to be standardized, and accumulation of further evidence is awaited.</p>

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