⚠️Simple Food Protein Induced Enterocolitis Syndrome (𝐅𝐏𝐈𝐄𝐒) or Food Protein Induced Proctocolitis (𝐅𝐏𝐈𝐏) is often mistaken for a viral infection causing vomiting and diarrhoea, with occasional blood in stool.
‼️Often, and not wrongly, it may be diagnosed as a 𝘯𝘰𝘯-𝘐𝘨𝘌 𝘢𝘭𝘭𝘦𝘳𝘨𝘺, with the most common being CMPA.
✅This is because it normally tends to have mild symptoms.
⁉️Important to note that severe 𝐅𝐏𝐈𝐄𝐒 is relatively rare and less common than Anaphylaxis!
✴𝐅𝐏𝐈𝐄𝐒 most common triggers:
▶️But can be associated with a long list of food proteins
🧒👧Most children will be able to tolerate the food causing the reaction by the age of 2 or 3 years old. In some cases, it may persist throughout life.
❗Children with recurrent episodes may suffer from poor growth and weight loss - failure to thrive.
✅Usually children will recover very fast from an episode of 𝐅𝐏𝐈𝐄𝐒, as long as appropriate diagnosis and treatment is made.
🔴For severe cases, the best treatment is fluid resuscitation.
⚠️What does not work to treat them:
Though you will often see all of them being used due to the worry it is either Anaphylaxis or Sepsis.
✴In the case of 𝐅𝐏𝐈𝐏, most symptoms tend to resolve by 6 months of age (50%) or 9 months of age (95%).
✳The advice is to reintroduce the causing food into the mother's diet after an exclusion period of 6 months or give it to the child when reaching 12 months of age.
⚠️For both cases, if the child is formula fed be aware that:
1️⃣Medical and dietetic advice needs to be sought before a restriction diet is done
2️⃣It might take 2 weeks for improvement to be seen
3️⃣The child will need and Extensively Hydrolysed Formula (EHF - first choice) or eventually an Amino Acid Formula (AAF - second choice)
❗In the case of a breastfeeding mother, a restriction diet needs to be guided by a dietitian.
✅This is to be sure appropriate nutrition (focusing on protein and calcium) is achieved.
‼️For 𝐅𝐏𝐈𝐄𝐒, there seems to be a 30% chance of people involved to develop either 𝘢𝘵𝘰𝘱𝘪𝘤 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴 (eczema), 𝘢𝘴𝘵𝘩𝘮𝘢 or 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 (allergic rhinitis).
⚠️Many people think that pet allergies are caused by a 🐕dog's or 🐈cat's fur (or any other pet, for what it matters), but the real source of pet allergies is often a protein that's in the saliva and urine of dogs and cats, also some produced in sebaceous glands. This protein sticks to the dead, dried flakes (dander) from your pet's skin.
❗Some cats or dogs may shed less dander than others, which potentially can lead to fewer symptoms.
👨💻The most interesting piece of research done so far came to the following conclusion:
▶️"There was no evidence for differential shedding of allergen by dogs grouped as hypoallergenic. Clinicians should advise patients that they cannot rely on breeds deemed to be "hypoallergenic" to, in fact, disperse less allergen in their environment."
(Dog allergen levels in homes with hypoallergenic compared with non-hypoallergenic dogs. Am J Rhinol Allergy. 2011 Jul-Aug;25(4):252-6. doi: 10.2500/ajra.2011.25.3606.)◀️.
🐰There is also extensive research done by Prof A. Custovic, related to the development of allergies to pets (can provide references if asked).
🔶️The most common symptoms seen in pet allergy are very similar to most other airborne allergens.
But they will vary depending on the person's own sensitivity to the pet in question.
❗The greater the skin prick test and/or specific IgE, the higher the chance to develop more severe symptoms.
➡️Sneezing or a runny or stuffy nose.
➡️Facial pain (from nasal congestion).
➡️Coughing, chest tightness, shortness of breath, and wheezing.
➡️Watery, red or itchy eyes.
➡️Skin rash or hives.
➡️Anaphylaxis - can happen, though it is extremely rare. There are one or two cases published, by the famous American Mayo Clinic, of dog anaphylaxis. More reports are to cat and 🐎horse.
The worse respiratory symptoms tend to be associated with someone who already has an underlying breathing pathology, like asthma, poorly controlled allergic rhinitis or recurrent wheeze of varied aetiology.
This potentially can lead to significant deterioration, often leading to hospital admission for treatment, often including moderate to intensive admissions and treatment.
Prof John Warner, one of the best known worldwide experts in Allergy, has once said that "If you remove a cat from home, you clean all the walls down, do the laundry, do the draperies, it still takes six months for the level of cat protein to get down to normal."
More of less the same will apply to dogs.
Research done by Allergist Dana Wallace, MD, has shown cat dander to be the smallest among pets. This means it will remain airborne for at least 30mins after being disturbed, leading to constant exposure to it.
What to do?
Depending on the severity of symptoms, you might need to avoid the pet (leading to allergic symptoms) completely.
If mild, then you can try mild avoidance and cleaning methods, like:
➡️Keep the dog out of your bedroom and restrict it to only a few rooms. Be advised that keeping the dog in only one room will not limit the allergens to that room.
➡️Don't pet, hug or kiss the dog; if you do, wash your hands with soap and water.
➡️High-efficiency particulate air (HEPA) cleaners run continuously in a bedroom or living room can reduce allergen levels over time.
➡️Regular use of a high-efficiency vacuum cleaner or a central vacuum can reduce allergen levels.
➡️Wash soft furnishings like duvet covers, curtains, cushions, soft toys on a hot wash cycle.
➡️Bathing your dog at least once a week can reduce airborne dog allergen.
➡️For horse allergy, remove all clothing, bag it, take a shower, before getting in contact with the person allergic to horses.
➡️Nasal symptoms are often treated with steroid nasal sprays, oral antihistamines or other oral medications.
➡️Eye symptoms are often treated with antihistamine eye drops.
➡️Respiratory or asthma symptoms can be treated with inhaled corticosteroids or bronchodilators to prevent or relieve respiratory symptoms.
How many of you have complained that you feel your lips or mouth tingling after eating some fruits or vegetables?
🤧If you also suffer from Hayfever, we are talking about Oral Allergy Syndrome, also known as Pollen Food Syndrome.
⚠️𝗪𝐡𝐚𝐭 𝐢𝐬 𝐢𝐭 𝐭𝐡𝐞𝐧?
This is an allergic reaction, with swelling and itchiness, affecting the mouth, 👄lips, 👅tongue, and throat only.
🔶️Usually, the symptoms are seen within a few minutes of eating certain fruits and vegetables, mainly when they are raw.
It is not common to cause swelling of the throat.
Even less common to cause anaphylaxis.
⚠️𝗪𝐡𝐲 𝐝𝐨𝐞𝐬 𝐭𝐡𝐢𝐬 𝐡𝐚𝐩𝐩𝐞𝐧?
Some proteins in foods are similar to some of the proteins found in certain pollens, so a cross-reaction might occur. That is also why it is called Pollen Food Syndrome.
⚠️𝗪𝐡𝐞𝐧 𝐜𝐚𝐧 𝐬𝐲𝐦𝐩𝐭𝐨𝐦𝐬 𝐬𝐭𝐚𝐫𝐭?
🧒For a child to suffer from hayfever, they usually need to be exposed to 2 pollen seasons.
For Oral Allergy Syndrome to develop, they need to be exposed to the food causing the reaction, many times.
This means it is not common to find it in toddlers.
⚠️𝐒𝐨 𝐢𝐭 𝐦𝐚𝐢𝐧𝐥𝐲 𝐚𝐟𝐟𝐞𝐜𝐭𝐬:
This type of symptoms are not associated only with the pollen season, this as we can find those foods available throughout the year.
Saying this, symptoms usually are higher when the pollen count is also higher.
⚠️𝗪𝐡𝐚𝐭 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐜𝐨𝐦𝐦𝐨𝐧 𝐩𝐨𝐥𝐥𝐞𝐧𝐬 𝐰𝐞 𝐧𝐞𝐞𝐝 𝐭𝐨 𝐥𝐨𝐨𝐤 𝐟𝐨𝐫, 𝐭𝐨 𝐬𝐚𝐲 𝐭𝐡𝐞𝐫𝐞 𝐢𝐬 𝐚 𝐜𝐨𝐧𝐧𝐞𝐜𝐭𝐢𝐨𝐧?
🔷️𝘎𝘳𝘢𝘴𝘴𝘦𝘴 (𝘢𝘴𝘴𝘰𝘤𝘪𝘢𝘵𝘪𝘰𝘯 𝘪𝘴 𝘥𝘰𝘶𝘣𝘵𝘧𝘶𝘭)
➡️Ragweed (association still unclear)
➡️Parietaria species (a member of the Urticaceae family - nettles among others)
⚠️𝗪𝐡𝐚𝐭 𝐜𝐚𝐧 𝐰𝐞 𝐝𝐨 𝐚𝐛𝐨𝐮𝐭 𝐢𝐭?
We usually suggest that parents or patients cook the fruits or vegetables that might be causing the symptoms.
➡️This is because the protein involved in this reaction is not stable to high heat, thus changing its form leading to the absence of reactions in most patients.
⚠️Caution as in the case of roasted hazelnuts and cooked celeriac, in some cases, minute amounts of the protein might still cause symptoms in highly sensitized patients.
✅There is also the possibility that immunotherapy directed at the pollen involved in the cross-reaction, might lead to a decrease of symptoms.
🔶️After having a diagnosis made (and this is one of the reasons component diagnostics are needed), a dietitian's cooperation is required, so appropriate follow-up and plan to introduce other foods that are closely related to the one initially the patient reacted to.
If your child has a reaction, the best course of action is:
- give antihistamines
- call 999 if worried
- avoid food(s) thought to be causing symptoms
- ask GP to refer to a Consultant Paediatric Allergist
🌞As the weather warms up, starts raining less and flowers start blooming, my clinic begins getting filled with (as Prof Warner likes to call them) itchy, sneezy, wheezy patients.
💐And this because they suffer with Allergic rhinitis, which is an inflammation of the nasal mucosa caused by an airborne allergen.
These can be either tree pollen or grass pollen.
The name Allergic Rhinitis wasn't used until the 20th Century.
Initially it was called "Summer Catarrh" as described by Dr Bostock, when an association was made with the hay season.
Due to that is was then commonly called "Hayfever", with the name persisting up to now.
The name "Allergic Rhinitis" is the true name of this pathology.
Allergic due to the reaction being made by allergens.
Rhinitis is due to the combination of two Greek words:
The main cause, aroud Spring and Summer, is Pollen.
Being it from Trees or from Grasses.
But Allergic Rhinits can also be due to other airborne allergens. Such as:
⚠️On its own, it is not life threatening.
⚠️The main problem is when associated with poorly or uncontrolled asthma.
⚠️Can also be troublesome for sufferers of Pollen Food Syndrome/Oral Allergy Syndrome.
The most common symptoms are:
🔶️Itching: Nose, eyes, ears, palate
🔶️Loss of smell
🔶️Runny and/or red eyes
✅Skin prick tests are the main source for diagnosis.
💉Blood tests can eventually be done, mainly in primary care.
❓What to do:
𝘚𝘰𝘰𝘯 𝘐'𝘭𝘭 𝘮𝘢𝘬𝘦 𝘢 𝘱𝘰𝘴𝘵 𝘰𝘯 𝘗𝘰𝘭𝘭𝘦𝘯 𝘍𝘰𝘰𝘥 𝘚𝘺𝘯𝘥𝘳𝘰𝘮𝘦 𝘢𝘯𝘥 𝘦𝘹𝘱𝘭𝘢𝘪𝘯 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴, 𝘪𝘯𝘷𝘦𝘴𝘵𝘪𝘨𝘢𝘵𝘪𝘰𝘯 𝘢𝘯𝘥 𝘵𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵.
𝘒𝘦𝘦𝘱 𝘺𝘰𝘶𝘳 𝘦𝘺𝘦𝘴 𝘱𝘦𝘦𝘭𝘦𝘥!
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.