Clinical-Hematological Changes and Predictors of Severity in Acute Food Protein-Induced Enterocolitis Syndrome Reactions at Oral Food Challenge: A Multicenter Observational Study
Por:
Argiz L, Valsami-Fokianos M, Arasi S, Barni S, Boscia S, Bracaglia G, Bracamonte T, Carballeira I, Dinardo G, Echeverria L, Garcia E, Garcia-Magan C, Gomez-Rial J, Gonzalez-Delgado P, Fiocchi A, Garriga T, Ibrahim T, Infante S, Machinena A, Mangone G, Mori F, Moure JD, O'Valle V, Pascal M, Pecora V, Prieto A, Quevedo S, Salas A, Vazquez-Cortes S, Vila L, Martinon-Torres F, Gomez-Carballa A, Boyle RJ and Vazquez-Ortiz M
Publicada:
1 sep 2024
Ahead of Print:
1 sep 2024
Resumen:
Background: Oral food challenge (OFC) is the criterion standard for diagnosis of acute food protein-induced enterocolitis syndrome (FPIES). No diagnostic/prognostic biomarkers are available, and OFC assessment criteria are not validated. Objective: To assess clinical-hematological changes and predictors of severity of FPIES reactions at OFC. Methods: This was an observational multicenter prospective study. Children aged 0 to 18 years diagnosed with acute FPIES were recruited at follow-up OFC in 12 tertiary centers in Spain and Italy. OFC outcomes (as positive/negative/inconclusive and mild/moderate/severe) were assessed on the basis of published "2017 FPIES Consensus" criteria. Clinical characteristics were recorded, and full blood cell count was done at baseline, reaction onset, and 4 hours later. Regression analysis was performed to assess predictors of severe reactions at OFC. Results: A total of 81 children had positive OFC (mild in 11% [9 of 81], moderate in 61% [49 of 81], and severe in 28% [23 of 81]). Increase in neutrophils and reduction in eosinophils, basophils, and lymphocytes were observed (P < .05). OFC was inconclusive in 19 cases despite objective signs or neutrophilia. Regression analysis showed that a 2-day OFC protocol where only 25% of an age-appropriate portion is given on day 1 (not sex, age, culprit food, cumulative dose, and previous reaction severity) was associated with reduced odds of severe reaction compared with giving multiple doses in a single day. Conclusions: Distinct hematological changes may help support FPIES diagnosis. Current OFC assessment criteria may not capture the broad spectrum of acute FPIES presentations. This 2-day protocol may be associated with a reduced risk of severe reactions. Future work should aim to develop safer OFC and non-OFC diagnostics for FPIES. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). (J Allergy Clin Immunol Pract 2024;12:2454-67)
Filiaciones:
Argiz L:
Department of Allergy, Clinica Universidad de Navarra, Pamplona, Spain
RICORS Red De Enfermedades Inflamatorias (REI) - RD21/0002/0028, Madrid, Spain
Valsami-Fokianos M:
National Heart and Lung Institute, Imperial College London, London, United Kingdom
Arasi S:
Allergy Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
Barni S:
Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
Boscia S:
Division of Immunology, Meyer Children's Hospital IRCCS, Florence, Italy
Department of Health Sciences, University of Florence, Florence, Italy
Bracaglia G:
Laboratory Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
Bracamonte T:
Paediatric Allergy Section, Severo Ochoa University Hospital, Madrid, Spain
Carballeira I:
Paediatric Allergy Section, Arquitecto Marcide Hospital, Coruña, Spain
Dinardo G:
Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
Echeverria L:
Paediatric Allergy Section, Severo Ochoa University Hospital, Madrid, Spain
Garcia E:
Paediatric Allergy Section, Arquitecto Marcide Hospital, Coruña, Spain
Garcia-Magan C:
Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Coruña, Spain
Gomez-Rial J:
Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Gonzalez-Delgado P:
Allergy Department, General University Hospital, Alicante, Spain
Fiocchi A:
Allergy Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
Garriga T:
Paediatric Allergy Section, Vall D'Hebron University Hospital, Growth and Development Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
Ibrahim T:
National Heart and Lung Institute, Imperial College London, London, United Kingdom
Allergy and Immunology Division, Hamad Medical Corporation, Doha, Qatar
Infante S:
Pediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Gregorio Marañón Health Research Institute, IiSGM, Madrid, Spain
Machinena A:
Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
Mangone G:
Division of Immunology, Meyer Children's Hospital IRCCS, Florence, Italy
Mori F:
Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
Moure JD:
Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Coruña, Spain
O'Valle V:
Paediatric Allergy Section, Severo Ochoa University Hospital, Madrid, Spain
Pascal M:
Immunology Department, CDB, Hospital Clínic de Barcelona, Barcelona, Spain
IDIBAPS, Universitat de Barcelona, Barcelona, Spain
Pecora V:
Allergy Unit, Department of Pediatric Medicine, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
Prieto A:
Paediatric Allergy Section, General University Hospital, Malaga, Spain
Quevedo S:
Paediatric Allergy Section, Severo Ochoa University Hospital, Madrid, Spain
Salas A:
Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigación Sanitaria (IDIS), Hospital Clínico Universitario de Santiago de Compostela (SERGAS), Galicia, Spain
Vazquez-Cortes S:
Allergy Department, Clinico San Carlos Hospital, Madrid, Spain
Vila L:
Paediatric Allergy Section, Teresa Herrera Hospital, Coruña, Spain
Martinon-Torres F:
Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Coruña, Spain
Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
Gomez-Carballa A:
Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigación Sanitaria (IDIS), Hospital Clínico Universitario de Santiago de Compostela (SERGAS), Galicia, Spain
Boyle RJ:
Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
Vazquez-Ortiz M:
Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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