Síndrome de Enterocolite Induzida por Proteína Alimentar (FPIES): um novo diagnóstico diferencial para alergia alimentar
Food Protein-Induced Enterocolitis Syndrome (FPIES): a new differential diagnosis for food allergy
Yara Henrique Martins Costa; Lúcia Gutheil-Gonçalves; Denise Tiemi-Miyakawa; Cristine Secco Rosário; Débora Carla Chong-Silva; Carlos Antônio Riedi; Nelson Augusto Rosario-Filho; Herberto Jose Chong-Neto
Resumo
A síndrome de enterocolite induzida por proteína alimentar, conhecida como “FPIES” (do inglês: Food Protein-Induced Enterocolitis Syndrome) é uma das apresentações da alergia alimentar não IgE mediada. Tema antes considerado raro, torna-se cada vez mais frequente nos pronto-atendimentos pediátricos. Através dos dados disponíveis na literatura, buscou-se relatar apresentação, diagnóstico e manejo da FPIES. Foi realizada busca ativa na base de dados PubMed do termo “food protein-induced enterocolitis” entre 2014 e 2019. Foram selecionados os artigos cuja população em estudo compunha a faixa etária pediátrica, e artigos completos que estavam disponíveis. Os pacientes usualmente descritos são lactentes com vômitos incoercíveis, diarreia, palidez, letargia e desidratação. Destes, alguns casos evoluem para choque hipovolêmico e acidose metabólica, podendo levar a diagnósticos equivocados. A proteína do leite de vaca, soja e arroz compõem os principais desencadeantes da doença. Entretanto, há diversos alimentos descritos neste processo. O diagnóstico dá-se através de história clínica compatível associada à reprodutibilidade dos sintomas quando ocorre reexposição ao alimento suspeito. O manejo agudo fundamenta-se na expansão volêmica, ondansetrona e corticoide, nos casos graves. Devido aos múltiplos fenótipos existentes, curto período de estudo, prevalência e patogenia incerta, a FPIES apresenta muitas lacunas a serem preenchidas. Assim, o presente estudo apresenta os consensos disponíveis e divergências atuais. Descritores: Hiperse
Palavras-chave
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy. Previously considered a rare event, it has become more frequent in pediatric care. This study aimed to report current literature findings on clinical presentation, diagnosis, and management of FPIES. An active search was conducted using PubMed database for the term “food-induced enterocolitis” in studies published between 2014 and 2019. Articles were selected if they involved a pediatric population and were available as full text. Samples usually consist of infants presenting with uncontrollable vomiting, diarrhea, pallor, lethargy, and dehydration. Some cases progress to hypovolemic shock and metabolic acidosis, leading to misdiagnosis. Milk, rice and soy proteins are the main triggers of the disease. The suspicion of FPIES is raised by clinical history associated with reproducible symptoms when re-exposure occurs. Acute management is based on volume infusion, ondansetron and corticosteroids in severe cases. Many gaps still exist in the knowledge of FPIES because of its multiple phenotypes, short-term studies, and uncertain prevalence and pathogenesis. The present study presents the available guidelines and current controversies.
Keywords
Referências
1. Nowak-Węgrzyn A, Chehade M, Groetch M, Spergel J, Wood R, 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 Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111-26.
2. Agyemang A, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome: a Comprehensive Review. Clin Rev Allergy Immunol. 2019; Feb 8. doi: 10.1007/s12016-018-8722-z. [Epub ahead of print].
3. Mehr S, Campbell D. Food protein-induced enterocolitis syndrome: guidelines summary and practice recommendations. Med J of Aust. 2019;210(2):94-9.
4. Venter C, Groetch M. Nutritional management of food proteininduced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):255-62.
5. Feuille E, Nowak-Węgrzyn A. Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):222-8.
6. Nowak-Węgrzyn A, Jarocka-Cyrta E, Moschione Castro A. Food Protein-Induced Enterocolitis Syndrome. J Invest Allergol Clin Immunol. 2017;27(1):1-18.
7. Kimura M, Shimomura M, Morishita H, Meguro T, Seto S. Eosinophilia in infants with food protein-induced enterocolitis syndrome in Japan. Allergol Intern. 2017;66(2):310-6.
8. Berin M. Immunopathophysiology of food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2015;135(5):1108‑13.
9. Guibas G, Tsabouri S, Makris M, Priftis K. Food protein-induced enterocolitis syndrome: Pitfalls in the diagnosis. Pediatr Allergy Immunol. 2014;25(7):622-9.
10. Mehr S, Frith K, Campbell D. Epidemiology of food proteininduced enterocolitis syndrome. Cur Opin Allergy Clin Immunol. 2014;14(3):208-16.
11. Mehr S, Frith K, Barnes E, Campbell D, Allen K, Barnes E, et al. Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012-2014. J Allergy Clin Immunol. 2017;140(5):1323‑30.
12. Katz Y, Goldberg M. Natural history of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):229-39.
13. Sarinho E, Lins M. Severe forms of food allergy. J Pediatr (Rio J). 2017;93:53-9.
14. Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome and allergic proctocolitis. Allergy Asthma Proc. 2015;36(3):172-84.
15. Turnbull J, Adams H, Gorard D. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther. 2015;41(1):3-25.
16. Mane S, Bahna S. Clinical manifestations of food proteininduced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):217-21.
17. Weinberger T, Feuille E, Thompson C, Nowak-Węgrzyn A. Chronic food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol. 2016;117(3):227-33.
18. Fiocchi A, Claps A, Dahdah L, Brindisi G, Dionisi-Vici C, Martelli A. Differential diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):246-54.
19. Yang M, Geng L, Xu Z, Chen P, Friesen C, Gong S, et al. Severe Food Protein-Induced Enterocolitis Syndrome to Cow’s Milk in Infants. Nutrients. 2015;8(1):1.
20. Bingemann T, Sood P, Järvinen K. Food Protein-Induced Enterocolitis Syndrome. Immunol Allergy Clin North America. 2018;38(1):141‑52.
21. Cherian S, Varshney P. Food Protein-Induced Enterocolitis Syndrome (FPIES): Review of Recent Guidelines. Curr Allergy Asthma Rep. 2018;18(4):28.
22. Schultz F, Westcott-Chavez A. Food protein-induced enterocolitis syndrome from the parent perspective. Curr Opin Allergy Clin Immunol. 2014;14(3):263-7.
23. Kimura M, Ito Y, Shimomura M, Morishita H, Meguro T, Adachi Y, et al. Cytokine profile after oral food challenge in infants with food protein-induced enterocolitis syndrome. Allergol Intern. 2017;66(3):452-7.
24. Kimura M, Shimomura M, Morishita H, Meguro T, Seto S. Serum C-reactive protein in food protein-induced enterocolitis syndrome versus food protein-induced proctocolitis in Japan. Pediatr Intern. 2016;58(9):836-41.
25. Kimura M, Ito Y, Tokunaga F, Meguro T, Shimomura M, Morishita H, et al. Increased C-reactive protein and fever in Japanese infants with food protein-induced enterocolitis syndrome. Pediatr Intern. 2016;58(9):826-30.
26. Fiocchi A, Dionisi-Vici C, Cotugno G, Koch P, Dahdah L. FruitInduced FPIES Masquerading as Hereditary Fructose Intolerance. Pediatrics. 2014;134(2):e602-e605.
27. Feuille E, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy. Curr Allergy Asthma Rep. 2015;15(8):50.
28. Connors L, O’Keefe A, Rosenfield L, Kim H. Non-IgE-mediated food hypersensitivity. Allergy Asthma Clin Immunol. 2018;14(S2). doi:10.1186/s13223-018-0285-2.
29. Miceli Sopo S, Battista A, Greco M, Monaco S. Ondansetron for Food Protein-Induced Enterocolitis Syndrome. Int Arch Allergy Immunol. 2014;164(2):137-9.
30. Miceli Sopo S, Bersani G, Monaco S, Cerchiara G, Lee E, Campbell D, et al. Ondansetron in acute food protein-induced enterocolitis syndrome, a retrospective case-control study. Allergy. 2016;72(4):545-51.
31. Michelet M, Schluckebier D, Petit L, Caubet J. Food protein-induced enterocolitis syndrome; a review of the literature with focus on clinical management. J Asthma Allergy. 2017;10:197-207.
32. Sdravou K, Emmanouilidou-Fotoulaki E, Mitakidou M, Printza A, Evangeliou A, Fotoulaki M. Children with diseases of the upper gastrointestinal tract are more likely to develop feeding problems. Ann Gastroenterol. 2019;May-Jun;32(3):217-33. doi: 10.20524/ aog.2019.0348. Epub 2019 Jan 15.
33. Meyer R, Godwin H, Dziubak R, Panepinto J, Foong R, Bryon M, et al. The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies. World Allergy Organ J. 2017;10(1):8.
34. Miceli Sopo S, Monaco S, Greco M, Scala G. Chronic food protein-induced enterocolitis syndrome caused by cow's milk proteins passed through breast milk. Int Arch Allergy Immunol. 2014;164(3):207-9.
35. Ntoumpara M, Sotiriadou F, Fotoulaki M. Acute-on-chronic food protein-induced enterocolitis syndrome in an exclusively breast-fed infant. Clin Case Rep. 2018;7(1):71-3.
36. Kimura M, Shimomura M, Morishita H, Meguro T. Prognosis of infantile food protein-induced enterocolitis syndrome in Japan. Pediatr Intern. 2017;59(8):855-60.
37. Caubet J, Ford L, Sickles L, Järvinen K, Sicherer S, Sampson H, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134(2):382-9.
38. Meyer R, De Koker C, Dziubak R, Godwin H, Dominguez-Ortega G, Chebar Lozinsky A, et al. The impact of the elimination diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies. Clin Trans Allergy. 2016;6(1):25.
39. Greenhawt M, Bird J, Nowak-Węgrzyn A. Trends in provider management of patients with Food Protein-Induced Enterocolitis Syndrome. J Allergy Clin Immunol In Pract. 2017;5(5):1319-24.
Submetido em:
23/09/2019
Aceito em:
30/09/2019
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email