Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management

Food protein-induced enterocolitis syndrome (FPIES) is a potentially severe presentation of non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) with heterogeneous clinical manifestations. Acute FPIES is typically characterized by profuse vomiting and lethargy, occurring classically 1-4 hours after ingestion of the offending food. When continuously exposed to the incriminated food, a chronic form has been described with persistent vomiting, diarrhea, and/or failure to thrive. Although affecting mainly infants, FPIES has also been described in adults. Although FPIES is actually one of the most actively studied non-IgE-GI-FAs, epidemiologic data are lacking, and estimation of the prevalence is based on a limited number of prospective studies. The exact pathomechanisms of FPIES remain not well defined, but recent data suggest involvement of neutrophils and mast cells, in addition to T cells. There is a wide range of food allergens that can cause FPIES with some geographical variations. The most frequently incriminated foods are cow milk, soy, and grains in Europe and USA. Furthermore, FPIES can be induced by foods usually considered as hypoallergenic, such as chicken, potatoes or rice. The diagnosis relies currently on typical clinical manifestations, resolving after the elimination of the offending food from the infant's/child's diet and/or an oral food challenge (OFC). The prognosis is usually favorable, with the vast majority of the case resolving before 5 years of age. Usually, assessment of tolerance acquisition by OFC is proposed every 12-18 months. Of note, a switch to an IgE-mediated FA is possible and has been suggested to be associated with a more severe phenotype. Avoiding the offending food requires education of the family of the affected child. A multidisciplinary approach including ideally allergists, gastroenterologists, dieticians, specialized nurses, and caregivers is often useful to optimize the management of these patients, that might be difficult

Anticorps anti-HLA spécifiques contre le donneur et rejet de greffe hépatique pédiatrique : prévalence et corrélation entre leurs caractéristiques et la survenue de rejet aigü

Background Despite growing interest about the impact of donor specific anti-HLA antibodies (DSA) in liver transplantation (LT) little is known about their role in T cell-mediated rejection (TCMR) or in pediatric recipients. Aim To analyze whether the presence of DSA was associated with the development of TCMR in pediatric LT recipients and to identify factors potentially associated with the development of de novo DSA post LT. Methods Retrospective single-center study involving children (0-16 years) having undergone LT between 01.01.2005 - 31.12.2015. Serum obtained before LT and at LB was analyzed for presence of recipient anti-HLA-antibody. Results The overall prevalence of de novo DSA was 70.2%, most of them class II. Preformed DSA were present in 18/57 (31.6%) of patients. Twenty-eight (28/57) patients (49.1%) presented at least one TCMR episode, mostly (12/28, 42.9%) mild (Banff 4-5). Neither preformed- nor de novo DSA were associated with the incidence or severity of TCMR