Síndrome de enterocolite induzida por proteína alimentar como diagnóstico diferencial das alergias alimentares: relato de caso
Food protein-induced enterocolitis syndrome as a differential diagnosis for food allergies: a case report
Haroldo Teófilo de-Carvalho; Daniela Mitsue Suzuki; Patrícia Golgato Aguiar; Paula Ravanelli Rossi; Cristiane Felipe Toniolo; Deborah Carvalho Cavalcanti
Resumo
A síndrome da enteropatia induzida por proteína alimentar, aguda ou crônica, é um tipo de alergia alimentar não mediada por IgE, que surge entre os 5 e 9 meses de idade, e é caracterizada por episódios de vômitos que começam aproximadamente 1 a 4 horas após a ingestão do alérgeno, algumas vezes acompanhados de letargia, palidez cutânea e diarreia com sangue, resultando em instabilidade hemodinâmica e choque em 15% dos casos. Sua epidemiologia em larga escala é desconhecida, assim como o mecanismo imunopatológico, no entanto, sugere-se um papel importante das células T no processo inflamatório. As manifestações e a gravidade dependem da frequência e da dose do alimento desencadeante, bem como do fenótipo e da idade de cada paciente. A suspeita se dá com base principalmente na história clínica e nos sintomas característicos da doença, que tendem a melhorar após a retirada do alimento suspeito. O teste de provocação oral é o padrão ouro para o diagnóstico, mas deve ser reservado para os casos em que a história é confusa e a hipótese incerta. A abordagem de primeira linha no tratamento visa corrigir a desidratação ou estabilizar o choque quando presente, e interromper imediatamente a oferta de alimentos com potencial indutor de reação alérgica. Relatamos o caso de uma lactente de 2 meses de idade com diagnóstico da síndrome, cujo objetivo é atentar o leitor quanto as suas particularidades, auxiliando-o no diagnóstico precoce e adequado a fim de evitar a depleção progressiva e a evolução para sua forma potencialmente grave.
Palavras-chave
Abstract
Acute or chronic food protein-induced enteropathy syndrome is a type of non-IgE-mediated food allergy occurring between 5 and 9 months of age. It is characterized by episodes of vomiting that begin approximately 1 to 4 hours after allergen intake, sometimes accompanied by lethargy, skin pallor, and bloody diarrhea, leading to hemodynamic instability and shock in 15% of cases. Its epidemiology is largely unknown, as well as its immunopathological mechanism; however, an important role of T cells in the inflammatory process is observed. Manifestations and severity depend on the frequency and dose of the triggering food, as well as the phenotype and age of each patient. Suspicion is based mainly on clinical history and characteristic symptoms of the disease, which tend to improve after the removal of the suspect food. Oral provocation testing is the gold standard for diagnosis, but it should be reserved for cases whose history is confusing and hypothesis is uncertain. The first-line treatment approach seeks to correct dehydration or to stabilize shock, if present, and to immediately stop the supply of food that potentially induce an allergic reaction. We report the case of a 2-month-old infant diagnosed with the syndrome, with the aim of drawing the readers’ attention to its particularities, thus assisting in early and adequate diagnosis in order to avoid progressive depletion and deterioration to its potentially severe form.
Keywords
References
1. Solé D, Silva LR, Cocco RR, Ferreira CT, Sarni RO, Oliveira LC, et al. Consenso Brasileiro sobre Alergia Alimentar: 2018 – Parte 1 – Etiopatogenia, clínica e diagnóstico. Documento conjunto elaborado pela Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunologia. Arq Asma Alerg Imunol. 2018;2(1):7-38.
2. Feuille E, Nowak-Wegrzyn A. Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):222-8.
3. Nowak-Wegrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, 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.
4. Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow’s milk: a large- scale, prospective population-based study. J Allergy Clin Immunol. 2011;127:647-53.
5. Özdemir Ö. Immuno pathogenesis of food protein induced enterocolitis syndrome (FPIES). MOJ Immunol. 2018;6(3):86-8.
6. Vila Sexto L. Latest insights on food protein-induced enterocolitis syndrome: An emerging medical condition. J Investig Allergol Clin Immunol. 2018;28(1):13-23.
7. Powell GK. Milk and soy induced enterocolitis of infancy. J Pediatr. 1978;93:553‑60.
8. Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, Spergel JM. Food protein induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013;1:343‑9.
9. Mehr S, Kakakios A, Frith K, Kemp AS. Food protein induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123:e459-e64.
10. Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. 2009;94:425‑8.
11. Yu W, Freeland DMH, Nadeau KC. Food allergy: immune mechanisms, diagnosis and immunotherapy. Nat Rev Immunol. 2016;16(12):751‑65.
12. Nowak-Wegrzyn A, Berin MC, Mehr S. Food ProteinInduced Enterocolitis Syndrome. J Allergy Clin Immunol Pract. 2020;8(1):24‑35.
13. Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134(2):382-9.
14. Leonard SA, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome: na update on natural history and review of management. Ann Allergy Asthma Immunol. 2011;107:95-101.
15. Nowak‑Wegrzyn A, Muraro A. Food protein‑induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2009;9:371‑7.
16. Costa YHM, Gutheil-Gonçalves L, Tiemi-Miyakawa D, Rosário CS, Chong-Silva DC, Riedi CA, et al. Síndrome de Enterocolite Induzida por Proteína Alimentar (FPIES): um novo diagnóstico diferencial para alergia alimentar. Arq Asma Alerg Imunol. 2019;3(3):259-68.
17. Agyemang A, Nowak-Wegrzyn A. Food protein induced enterocolitis syndrome: a comprehensive review. Clinic Rev Allerg Immunol. 2019;57:261‑71.
18. Baldo F, Bevacqua M, Corrado C, Nisticò D, Cesca L, Declich V, et al. FPIES in exclusively breastfed infants: two case reports and review of the literature. Ital J Pediatr. 2020;46:144.
19. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Fiori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis associated organ dysfunction in children. Intensiv Care Med. 2020;46(1):10-67.
20. Sopo SM, Battista A, Monaco SGM. Ondansetron for food protein-induced enterocolitis syndrome. Int Arch Allergy Immunol. 2014;164:137‑9.
21. Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. 2006;354:1698‑705.
22. Roslund G, Hepps TS, McQuillen KK. The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: A randomized controlled trial. Ann Emerg Med. 2008;52:22‑9.
23. 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.
24. 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.
Submitted date:
02/15/2021
Accepted date:
03/30/2021
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