Scientific publications
Clinical-haematological changes and predictors of severity in acute food protein-induced enterocolitis syndrome reactions at oral food challenge: a multicentre observational study
L Argiz 1 , M Valsami-Fokianos 2 , S Arasi 3 , S Barni 4 , S Boscia 5 , G Bracaglia 6 , T Bracamonte 7 , I Carballeira 8 , G Dinardo 9 , L Echeverria 10 , E Garcia 11 , C Garcia-Magan 12 , J Gomez-Rial 13 , P Gonzalez-Delgado 14 , A Fiocchi 15 , T Garriga 16 , T Ibrahim 17 , S Infante 18 , A Machinena 19 , G Mangone 20 , F Mori 21 , J D Moure 22 , V O'Valle 23 , M Pascal 24 , V Pecora 3 , A Prieto 25 , S Quevedo 26 , A Salas-Ellacuriaga 27 , S Vazquez-Cortes 28 , L Vila 29 , F Martinon-Torres 30 , A Gomez-Carballa 31 , R J Boyle 32 , M Vazquez-Ortiz 33
Background: Oral food challenge (OFC) is the gold 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-haematological changes and predictors of severity of FPIES reactions at OFC.
Methods: Observational multicentre prospective study. Children aged 0-18 years diagnosed with acute FPIES were recruited at follow-up OFC in 12 tertiary centres in Spain and Italy. OFC Outcomes (as positive/negative/inconclusive and mild/moderate/severe) were assessed based on published '2017 FPIES Consensus' criteria. Clinical characteristics were recorded, and full blood count was done at baseline, reaction onset and 4 hours later. Regression analysis was performed to assess predictors of severe reactions at OFC.
Results: 81 children had positive OFC (mild in 11% (9/81), moderate in 61% (49/81), severe in 28% (23/81)). Increase in neutrophils and reduction in eosinophils, basophils and lymphocytes was observed (P-value<0.05). OFC was inconclusive in 19 cases despite objective signs or neutrophilia. Regression analysis showed a 2-day OFC protocol where only 25% of an age-appropriate portion is given on day 1 (not gender, age, culprit food, cumulative dose and previous reaction severity) was associated with reduced odds of severe reaction compared to giving multiple doses in a single day.
Conclusion: Distinct haematological 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 associate a reduced risk of severe reactions. Future work should aim to develop safer OFC and non-OFC diagnostics for FPIES.
CITATION J Allergy Clin Immunol Pract. 2024 May 23:S2213-2198(24)00538-5. doi: 10.1016/j.jaip.2024.05.024
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