Non-IgE Mediated Symptoms in Allergic Disease

Question 1

What 3 main allergies are important to know?

Answer 1

Gastro-Oesophageal Reflux Disease – can present in a very similar way
Food Protein Induced Enterocolitis (FPIES)
Eosinophilic Oesophagitis

Question 2

KEY SYMPTOM IS VOMITING - ALWAYS REMEMBER ALLERGY

Answer 2

KEY SYMPTOM IS VOMITING - ALWAYS REMEMBER ALLERGY

Question 3

Food protein induced enterocolitis - FPIES:

What is it?

At what age does it occur?

Main symptom?

What would make you think of this instead of anaphylaxis?

Can look like SEPSIS!

What may give you a clue in the history?

Main food allergens?

Management - avoid trigger!
Manage according to symptoms - observation

Answer 3

Allergy to food - protein

Infancy (< 2yrs old)

Repetitive protracted VOMITING

Exclude:

• Absence of cutaneous and respiratory symptoms suggest a systemic reaction different from anaphylaxis.
• Fever (>38)

Repeated episodes of vomtiing within 4 HOURS of eating + REMOVAL leads to resolution

Milk
Eggs
Fish
Fruit and Veg

Question 4

Food protein induced enterocolitis - FPIES:

Other features - read?

Answer 4

If severe with cardiovascular collapse (Hypotension, pallor, floppiness):

• Refer to A&E
• Hypothermia
• Hypotension
• Presence of lethargy, floppiness and/or pallor – consider PICU admission
• Treat diarrhea within 24 hours of the initial reaction

Question 5

Eosinophilic Oesophagitis:

3 features of this?

Answer 5

(1) Dysphagia
(2) Bolus obstruction - An esophageal food bolus obstruction is a medical emergency caused by the obstruction of the esophagus by an ingested foreign body.
(3) Water brash is the sudden filling of the mouth with saliva that accompanies heartburn in some patients with reflux esophagitis

Question 6

Eosinophilic Oesophagitis:

How is it diagnosed?

Rx?

Answer 6

BIOPSY of oesophagus

Treated with oral corticosteroids and exclusion diets

Usually a missed diagnosis!