What is symptoms of food allergies
Frequently Asked Questions about Food Protein-Induced Enterocolitis Syndrome (FPIES)
Does FPIES Require Epinephrine?
Not generally, because epinephrine reverses IgE-mediated symptoms, and FPIES is not IgE-mediated. Based on the patient’s history, some doctors might prescribe epinephrine to reverse specific symptoms of shock (e.g., low blood pressure). However, this is only prescribed in specific cases.
How Do You Treat an FPIES Reaction?
Always follow your doctor’s emergency plan pertaining to your specific situation. Rapid dehydration and shock are medical emergencies. If your kid is experiencing symptoms of FPIES or shock, immediately contact your local emergency services (9-1-1).
If you are uncertain if your kid is in need of emergency services, contact 9-1-1 or your physician for guidance. The most critical treatment during an FPIES reaction is intravenous (IV) fluids, because of the risk and prevalence of dehydration. Children experiencing more severe symptoms may also need steroids and in-hospital monitoring. Mild reactions may be capable to be treated at home with oral electrolyte re-hydration (e.g., Pedialyte®).
What are Some Common FPIES Triggers?
The most common FPIES triggers are traditional first foods, such as dairy and soy.
Other common triggers are rice, oat, barley, green beans, peas, sweet potatoes, squash, chicken and turkey. A reaction to one common food does not mean that every of the common foods will be an issue, but patients are often advised to proceed with caution with those foods. Note that while the above foods are the most prevalent, they are not exclusive triggers. Any food has the potential to trigger an FPIES reaction. Even trace amounts can cause a reaction.
What is Shock and What are the Symptoms?
Shock is a life-threatening condition. Shock may develop as the result of sudden illness, injury, or bleeding.
When the body cannot get enough blood to the vital organs, it goes into shock.
Signs of shock include:
Weakness, dizziness, and fainting.
Cool, pale, clammy skin.
Weak, quick pulse.
Shallow, quick breathing.
Low blood pressure.
Extreme thirst, nausea, or vomiting.
Confusion or anxiety.
When Do FPIES Reactions Occur?
FPIES reactions often show up in the first weeks or months of life, or at an older age for the exclusively breastfed kid.
Reactions generally happen upon introducing first solid foods, such as baby cereals or formulas, which are typically made with dairy or soy. (Infant formulas are considered solids for FPIES purposes.) While a kid may own allergies and intolerances to food proteins they are exposed to through breastmilk, FPIES reactions generally don’t happen from breastmilk, regardless of the mother’s diet. An FPIES reaction typically takes put when the kid has directly ingested the trigger food(s).
What is FPIES?
FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea.
FPIES is presumed to be cell mediated. Poor growth may happen with continual ingestion. Upon removing the problem food(s), every FPIES symptoms subside. (Note: Having FPIES does not preclude one from having other allergies/intolerances with the food.) The most common FPIES triggers are cow’s milk (dairy) and soy. However, any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley.
A kid with FPIES may experience what appears to be a severe stomach bug, but the «bug» only starts a couple hours after the offending food is given.
Numerous FPIES parents own rushed their children to the ER, limp from extreme, repeated projectile vomiting, only to be told, «It’s the stomach flu.» However, the next time they feed their children the same solids, the dramatic symptoms return.
What Does FPIES Stand For?
FPIES is Food Protein-Induced Enterocolitis Syndrome. It is commonly pronounced «F-Pies», as in «apple pies», though some physicians may refer to it as FIES (pronounced «fees», considering food-protein as one word). Enterocolitis is inflammation involving both the little intestine and the colon (large intestine).
What Does IgE vs Cell Mediated Mean?
IgE stands for Immunoglobulin E.
It is a type of antibody, formed to protect the body from infection, that functions in allergic reactions. IgE-mediated reactions are considered immediate hypersensitivity immune system reactions, while cell mediated reactions are considered delayed hypersensitivity. Antibodies are not involved in cell mediated reactions. For the purpose of understanding FPIES, you can disregard every you know about IgE-mediated reactions.
How Do I know If My Kid Has Outgrown FPIES?
Together with your child’s doctor, you should determine if/when it is likely that your kid may own outgrown any triggers.
Obviously, determining if a kid has outgrown a trigger is something that needs to be evaluated on a food-by-food basis. As stated earlier, APT testing may be an option to assess oral challenge readiness. Another factor for you and your doctor to consider is if your kid would physically be capable to handle a possible failed challenge.
When the time comes to orally challenge an FPIES trigger, most doctors familiar with FPIES will desire to schedule an in-office food challenge. Some doctors (especially those not practicing in a hospital clinic setting) may select to challenge in the hospital, with an IV already in put, in case of emergency.
Each doctor may own his or her own protocol, but an FPIES trigger is something you should definitely NOT challenge without discussing thoroughly with your doctor.
Be aware that if a kid passes the in-office portion of the challenge, it does not mean this food is automatically guaranteed «safe.» If a child’s delay in reaction is fairly short, a kid may fail an FPIES food challenge while still at the office/hospital. For those with longer reaction times, it may not be until later that day that symptoms manifest. Some may react up to three days later. Delay times may vary by food as well.
If a kid has FPIES to multiple foods, one food may trigger symptoms within four hours; a diverse food may not trigger symptoms until six or eight hours after ingestion.
How Do You Care for a Kid With FPIES?
Treatment varies, depending on the patient and his/her specific reactions. Often, infants who own reacted to both dairy and soy formulas will be placed on hypoallergenic or elemental formula. Some children do well breastfeeding.
Other children who own fewer triggers may just strictly avoid the offending food(s).
New foods are generally introduced extremely slowly, one food at a time, for an extended period of time per food. Some doctors recommend trialing a single food for up to three weeks before introducing another.
Because it’s a rare, but serious condition, in the event of an emergency, it is vital to get the correct treatment. Some doctors provide their patients with a letter containing a brief description of FPIES and its proper treatment.
In the event of a reaction, this letter can be taken to the ER with the child.
Is FPIES A Lifelong Condition?
Typically, no. Numerous children outgrow FPIES by about age three. Note, however, that the time varies per individual and the offending food, so statistics are a guide, but not an absolute. In one study, 100% of children with FPIES reactions to barley had outgrown and were tolerating barley by age three. However, only 40% of those with FPIES to rice, and 60% to dairy tolerated it by the same age.
What is a Typical FPIES Reaction?
As with every things, each kid is diverse, and the range, severity and duration of symptoms may vary from reaction to reaction.
Unlike traditional IgE-mediated allergies, FPIES reactions do not manifest with itching, hives, swelling, coughing or wheezing, etc. Symptoms typically only involve the gastrointestinal system, and other body organs are not involved. FPIES reactions almost always start with delayed onset vomiting (usually two hours after ingestion, sometimes as tardy as eight hours after). Symptoms can range from mild (an increase in reflux and several days of runny stools) to life threatening (shock).
In severe cases, after repeatedly vomiting, children often start vomiting bile. Commonly, diarrhea follows and can final up to several days. In the worst reactions (about 20% of the time), the kid has such severe vomiting and diarrhea that s/he rapidly becomes seriously dehydrated and may go into shock.
How is FPIES Diagnosed?
FPIES is hard to diagnose, unless the reaction has happened more than once, as it is diagnosed by symptom presentation.
Typically, foods that trigger FPIES reactions are negative with standard skin and blood allergy tests (SPT, RAST) because they glance for IgE-mediated responses. However, as stated before, FPIES is not IgE-mediated.
Atopy patch testing (APT) is being studied for its effectiveness in diagnosing FPIES, as well as predicting if the problem food is no longer a trigger. Thus, the outcome of APT may determine if the kid is a potential candidate for an oral food challenge (OFC). APT involves placing the trigger food in a metal cap, which is left on the skin for 48 hours. The skin is then watched for symptoms in the following days after removal.
Please consult your child’s doctor to discuss if APT is indicated in your situation.
How is FPIES Diverse From MSPI, MSPIES, MPIES, Etc.?
MPIES (milk-protein induced enterocolitis syndrome) is FPIES to cow’s milk only. MSPIES (milk- and soy-protein induced enterocolitis syndrome) is FPIES to milk and soy. Some doctors do create these subdivisions, while others declare that milk and soy are simply the two most common FPIES triggers and give the diagnosis of «FPIES to milk and/or soy.»
MSPI is milk and soy protein intolerance.
Symptoms are those of allergic colitis and can include colic, vomiting, diarrhea and blood in stools. These reactions are not as severe or immediate as an FPIES reaction.
Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. (2006). Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome. Pediatric Allergy and Immunology 17: 351–355. Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_3/S116.
Burks, AW. (2006). Don’t Feed Her That! Diagnosing and Managing Pediatric Food Allergy. Pediatric Basics.
Gerber Products Company: 115. Retrieved on December 31, 2007 from http://www.gerber.com/content/usa/html/pages/pediatricbasics/articles/115_01-dontfeed.html.
Moore, D. Food Protein-Induced Enterocolitis Syndrome. (2007, April 11). Retrieved on December 31, 2007 from http://allergies.about.com/od/foodallergies/a/fpies.htm.
Sicherer, SH. (2005). Food Protein-Induced Enterocolitis Syndrome: Case Presentations and Management Lessons.
Journal of Allergy and Clinical Immunology Vol. 115, 1:149-156. Retrieved on December 31, 2007 from http://www.jacionline.org/article/PIIS0091674904024881/fulltext.
Nowak-Wegrzyn, A., Sampson, HA, Wood, RA, Sicherer, SH. MD, Robert A. Wood, MD and Scott H. Sicherer, MD. (2003). Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins. Pediatrics. Vol. 111. 4: 829-835. Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/full/111/4/829#T1.
Nocerino, A., Guandalini, S.
(2006, April 11). Protein Intolerance. Retrieved on December 31, 2007 from http://www.emedicine.com/ped/topic1908.htm. WebMD Medical Reference from Healthwise. (2006, May 31). Shock, Topic Overview. Retrieved on December 31, 2007 from http://www.webmd.com/a-to-z-guides/shock-topic-overview.
American Academy of Allergy, Asthma and Immunology. (2007). Tips to Remember: What is an Allergic Reaction? Retrieved on December 31, 2007 from http://www.aaaai.org/patients/publicedmat/tips/whatisallergicreaction.stm.
Sicherer, SH. (2006). Understanding and Managing Your Child’s Food Allergies. A Johns Hopkins Press Health Book.
Medical Review February 2008.
For Immediate Release Contact: Jo Ann Faber at (847) 427-1200 [email protected]
ARLINGTON HEIGHTS, Ill., July 24, 2009 Food allergy knowledge in the general public is poor concerning the difference between food allergy and food intolerance, the absence of a cure, and current treatments according to a report published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).
"The public s food allergy knowledge and awareness is critical to the safety of children with food allergy, especially since 76 percent of food allergy-related deaths follow consumption of foods exterior of the home.
Food allergy is a growing health concern, affecting an estimated 6 percent to 8 percent of children in the United States," said Ruchi S. Gupta, M.D., of the Mary Ann & J. Wilburn Smith Children Health Research Program at Children s Memorial Research Middle in Chicago.
In a national sample of 2,148 adults who completed the validated Web-based Chicago Food Allergy Research Survey for the General Public, Dr. Gupta and colleagues found "the public s knowledge was strongest regarding symptoms and severity of food allergy, with almost 95 percent of participants recognizing food allergy as a potentially fatal condition."
Among the misconceptions, investigators reported that "almost half of participants erroneously believed that a cure exists for food allergy, and more than two thirds stated that a daily medicine could be taken to prevent a food allergy reaction.
They also tended to overlook the necessity of strict allergen avoidance: more than 40 percent of participants indicated that other means exist to prevent life-threatening reactions."
Authors noted that almost 85 percent of respondents agreed that schools should own plans to hold food-allergic children safe.
"Although there was agreement that schools need better policies to manage food allergies, most parents were not in favor of implementation of specific school policies, such as banning peanut products and having special tables for food-allergic children," Dr.
Investigators conclude that "increased food allergy knowledge among the general public is needed, especially regarding the distinction between food allergy and food intolerance, current treatments available for food allergy, the absence of a cure, and the lack of preventative medications."
"Although food allergy is a commonplace term, this study confirms the prevailing misconceptions among the public regarding manifestations, diagnosis, and treatment," said Sami L.
Bahna, M.D., Dr.P.H., professor of pediatrics & medicine, chief of Allergy & Immunology Section at Louisiana State University Health Sciences Middle in Shreveport, La., and president-elect of ACAAI. "Appropriate diagnosis is the cornerstone for appropriate management. Also, exclusion of food allergy would direct the search to other causes of the patient s illness.
At present the treatment is basically strict avoidance of the causative foods. Research is underway for effective and safe immunotherapy."
To the author s knowledge, "this study is the first to provide detailed information about the general public s food allergy knowledge and to characterize the general public s attitudes and beliefs toward food allergy and food allergy policy."
About Food Allergy
Current treatment of food allergy includes identification and strict avoidance of the offending food, and recognition of systems that can lead to anaphylaxis. Anaphylaxis is the most severe form of allergic reactions, affecting multiple organ systems.
Symptoms can include chest tightness, wheezing, nausea, vomiting, cramping, hives, and swelling of the lips and joints. The most dangerous symptoms are breathing difficulties, throat swelling, chest wheezing, dizziness, low blood pressure, shock and loss of consciousness, every of which can be fatal. Patients with severe reactions should own continued access to self-istered epinephrine injections.
The most common food allergens in infants and young children are cow s milk, hen s egg, peanut (a legume), tree nuts (walnut, hazelnut, Brazil nut, and pecan), soybeans and wheat. Although sensitivity to most allergens is lost in tardy childhood, allergy to peanut, tree nut and seafood is likely to continue throughout the patient s life.
Only approximately 20 percent of children with peanut allergy lose their sensitivity. The most common foods causing allergy in adults are peanuts, tree nuts, fish, crustaceans, mollusks, fruits and vegetables.
Patient information on allergic diseases including food allergy is available by visiting the ACAAI Web site at AllergyandAsthmaRelief.org.
The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology.
The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.
Citation: Gupta RS,et al. Food allergy knowledge, attitudes, and beliefs in the United States. Ann Allergy Asthma Immunol 2009;103:43-50.
Annals of Allergy, Asthma & Immunology is online at www.annallergy.org.
Individuals with food allergy own an overreactive immune systemtowards aparticularfood.
Such a response happens due toan antibody calledIgE (Immunoglobulin E). Individuals suffering from food allergy often own a family history ofallergies.The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts.
The symptoms on food allergy may not depend on the quantity of allergenic food consumed and may even happen with consumption of tiny amounts. It is also significant to note that numerous allergens may cause symptoms even after they own been cooked, and even after undergoing the digestive process. On the other hand, some otherallergens, typically certain fruits and vegetables, may only cause allergies when consumed raw.
In some food groups, such as seafood andtree nuts, a phenomenon called cross-reactivity may be seen.
This implies that if an individual has an allergy to onemember of a food family, they may also beallergic to other members of the same food group. Interestingly, cross-reactivitymay not be as commonly seen infoods from animal groups. For example, it has been found that individuals who may own allergiesto cow’s milk may still be capable toeat beef. Similarly, individuals with egg allergies may still be abletoeat chicken. It has also been found thatamong shellfish, crustaceans (shrimp, crab and lobster) are most likely to cause an allergic reaction.
Other mollusks such as clams, oysters and scallops are somewhat lesscommonly associated with allergies.
Symptoms of Food Allergies:
Symptoms of allergic reactions are commonly dermatological in nature and may causeskin itching, hives and swelling. Vomiting and diarrhea are common gastrointestinal symptoms. Symptoms of the respiratory system generally happen onlyin conjunction withskin and gastrointestinal symptoms.
Severe Allergic Reactions:
Anaphylaxis is a serious allergic reaction that happens extremely quickly and needs immediate and urgent attention!The symptoms often includedifficulty in breathing, loss of consciousness and dizziness.
If you noticeany of these symptoms,especially after eating, call 911 rightaway. It is imperative to seek medical care immediately (call 911). Don’t wait to see if your symptoms go away or get better on their own. Without immediate treatment and effective and expert medical care, anaphylaxis can be lethal. It is essential to follow up with your allergist in such cases.
An allergist is the best qualified professional to diagnose food allergy. Your allergist will take a thorough medical history, followed by a physical examination. You may be asked about contents of the foods, the frequency, seasonality, severity and nature of your symptoms and the quantity of time between eating a food and any reaction.
Allergy skin tests may determine which foods, if any, trigger your allergic symptoms.
In skin testing, a little quantity of extract made from the food is placed on the back or arm. If a raised bump or little hive develops within 20 minutes, it indicates a possible allergy. If it does not develop, the test is negative. It is unusual for someone with a negative skin test to own an IgE-mediated food allergy.
In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. Your doctor may recommend a blood test. Untrue positive results may happen with both skin and blood testing. Food challenges are often required to confirm the diagnosis.
Food challenges are done by consuming the food in a medical setting to determine if that food causes a reaction.
Another question that is commonly asked is whether children outgrow their food allergies. It has been reported that most children may outgrow certain allergies such as those to soy, egg, cow’s milk, and wheat allergy, even if they own a history of a severe reaction. About 20% of children with peanut allergy will outgrow it. About 9% of children with tree nut allergy will outgrow it.
Your allergist can assist you study when your kid might outgrow a food allergy.
The best way to treat food allergy is to avoid the foods that trigger your allergy. Always check the ingredients when eating, especially when out of home. Carefully read labels that indicate food information.
Carefully read food labels. Always carry and know how to use injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people shut to you how to use epinephrine! It is also significant to wear an ID bracelet that describes your allergy.
Food allergies can be confusing and isolating. For support, you may contact the Food Allergy & Anaphylaxis Network (FAAN) at (800) 929-4040.
(Information only; not intended to replace medical advice; adapted from AAAAI)
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Cow`s milk protein allergy is not a minor ailment, it is a serious disease.
If untreated early and properly, it can pave the way for other serious illnesses, experts argued during a debate in Warsaw.
The theme of the debate was: «Milk allergy — a transient problem of infancy or a harbinger of further diseases». The data presented during the discussion show that food allergies happen in 9-10% children. One of the most common food allergens is cow`s milk protein, to which 3% newborns and babies are allergic.
National paediatric gastroenterology consultant Prof. Mieczysława Czerwionka-Szaflarska warned against underestimating child`s food allergies, especially the cow`s milk protein allergy.
«It`s not just a minor ailment, it is a serious disease» — she emphasized. Along with other experts, she warned that if the allergy is not sufficiently early and properly treated, at a later age of the kid it may also pave the way for other allergic diseases, such as atopic dermatitis, bronchial asthma and allergic rhinitis. This especially applies to IgE-mediated allergy, which consists in the immune system producing IgE antibodies specific for cow`s milk proteins.
Allergy to cow`s milk protein generally has a mild, moderate form — explained Prof. Piotr Albrecht, head of Department of Pediatric Gastroenterology and Nutrition of the Medical University of Warsaw.
«In 90 percent children, food allergy generally disappears in the period from 2 to 4 years of age. However, if it is poorly treated, it threatens the development of the so-called allergic march, that is, the emergence of other allergic diseases» — he stressed.
Experts emphasized the importance of early detection of food allergy.
Its symptoms may include eczema and skin rashes, diarrhoea, vomiting, constipation and gastro-oesophageal reflux, as well as respiratory ailments manifested by wheezing, coughing or sneezing, difficulty breathing, runny nose and swelling of the nose. «Children affected by this type of allergies sometimes scratch every day, sleep badly and become nervous» — emphasized Prof. Albrecht. Some babies do not own serious symptoms, they only refuse to take food.
Cow`s milk protein allergy, especially in its mild and moderate form, can be diagnosed by a primary care physician.
«A primary care physician can also prescribe allergy preparations that are refunded from the budget» — said Prof. Czerwionka-Szaflarska. The istration of such preparations, instead of the elimination diet, hard to implement in the case of cow`s milk protein, allows to avoid nutritional deficiencies.
The expert emphasised that when a kid receives milk for allergy sufferers, it should not be referred to a specialist, for example an allergist, because the specialist will not be capable to diagnose anything. In any case, only children with severe food allergies, which in extreme cases may even lead to anaphylactic shock (life-threatening significant reduction in blood pressure), should be referred to specialists.
Head of the Chair and Clinic of Allergology and Clinical Immunology and Internal Diseases of the Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz Prof.
Zbigniew Bartuzi noted that in some cases cow`s milk protein allergy may not be related to IgE antibodies. It causes similar symptoms, such as diarrhoea, flatulence, intestinal discomfort, but they generally appear later (from 1 hour to a few days after exposure to cow`s milk protein).
The specialist warned that one should not use so-called alternative allergy tests, such as iridology and hair testing, to detect allergies. «They are not dependable and do not permit to make the correct diagnosis» — he stressed. He added that if they were useful, allergists would be using them. Doctors use so-called spot tests to check individual substances that may be sensitising.
Food allergy is also confused with food intolerance, caused by deficiency or lack of enzymes necessary for the proper digestion of nutrients.
In the case of cow`s milk, some people lack the enzyme (lactase) or it is not fully functional in the breakdown of lactose (disaccharide in the milk of mammals).
According to Prof. Bartuzi, 30-35 percent Poles are cow`s milk intolerant, and some symptoms, such as stomach aches, bloating and diarrhoea in the form of foamy stools, may be similar to cow`s milk protein allergy. He noted that the age, at which cow`s milk tolerance appears, has been moved. In the 1990s, in 75 percent people it developed at the age of 5, and now on average at around 16 years of age. However, in an increasing number of people, it develops only during adulthood, or does not develop at all» — he explained.
Allergies are becoming more and more common.
According to the World Allergy Organization (WAO), 30-40 percent world population has at least one allergic disease, especially in the most industrialized countries. The Polish Allergy Society estimates that almost half of Poles are affected by allergies.
PAP — Science in Poland, Zbigniew Wojtasiński
zbw/ ekr/ kap/