ABSTRACT
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. Its pathophysiology is still poorly understood. FPIES mainly affects infant and young children, although cases have been reported in adults. Its symptomatology is restricted to gastrointestinal manifestations and the onset of allergic reaction subsequent to exposure is delayed. The most common culprit for children is cow's milk. Initial clinical presentation of FPIES is oftentimes acute, though it can also be chronic. Diagnosis relies on clinical criteria, which have been recently redefined and subject to international consensus. Through two clinical cases, this report aims to describe the characteristics of this emerging disease as well as delineate the treatment thereof.
Le syndrome d'entérocolite induite par les protéines alimentaires (SEIPA) est une allergie alimentaire non IgE-médiée dont la physiopathologie est encore mal connue. Elle touche principalement le jeune enfant, bien que des cas chez l'adulte soient décrits. Elle se caractérise par des symptômes uniquement digestifs et d'apparition retardée lors de l'exposition à l'allergène. L'aliment le plus fréquemment incriminé chez l'enfant est le lait de vache. Le SEIPA peut se présenter sous deux formes, aiguë ou chronique, la forme aiguë étant la plus fréquente. Son diagnostic repose, essentiellement, sur des critères cliniques qui ont été redéfinis, récemment, lors d'un consensus international. Ce travail, à travers deux cas cliniques, a pour objectif de décrire les caractéristiques de cette maladie émergente et de discuter des grandes lignes de son traitement.
Subject(s)
Enterocolitis , Food Hypersensitivity , Adult , Allergens , Animals , Cattle , Child , Child, Preschool , Dietary Proteins , Enterocolitis/diagnosis , Enterocolitis/etiology , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/etiology , Humans , Infant , SyndromeABSTRACT
Specific anti-polysaccharide antibody deficiency (SPAD) is an immune disorder. Diagnostic criteria have not yet been defined clearly. One hundred and seventy-six children evaluated for recurrent respiratory tract infections were analysed retrospectively. For each subject, specific anti-pneumococcal antibodies had been measured with two enzyme-linked immunosorbent assays (ELISAs), one overall assay (OA) using the 23-valent pneumococcal polysaccharide vaccine (23-PPSV) as detecting antigen and the other purified pneumococcal polysaccharide serotypes (serotype-specific assay, SSA) (serotypes 14, 19F and 23F). Antibody levels were measured before (n = 176) and after (n = 93) immunization with the 23-PPSV. Before immunization, low titres were found for 138 of 176 patients (78%) with OA, compared to 20 of 176 patients (11%) with the SSA. We found a significant correlation between OA and SSA results. After immunization, 88% (71 of 81) of the patients considered as responders in the OA test were also responders in the SSA; 93% (71 of 76) of the patients classified as responders according to the SSA were also responders in the OA. SPAD was diagnosed in 8% (seven of 93) of patients on the basis of the absence of response in both tests. Thus, we propose to use OA as a screening test for SPAD before 23-PPSV immunization. After immunization, SSA should be used only in case of a low response in OA. Only the absence of or a very low antibody response detected by both tests should be used as a diagnostic criterion for SPAD.