Keywords
Alergia alimentaria no mediada por IgE
Proctocolitis alérgica inducida por proteínas alimentarias
Hematoquecia
Probióticos
Microbiota fecal
Abstract
La alergia alimentaria es una respuesta inmunitaria a las proteínas de los alimentos. Suele afectar al 8% de los niños y al 2% de los adultos en países occidentales. La alergia alimentaria no mediada por IgE afecta, principalmente, el aparato gastrointestinal. Las alergias alimentarias gastrointestinales se clasifican, por su patogenia subyacente, en: mediadas por IgE, no mediadas por IgE, o mixtas. Los síntomas de pacientes con proctocolitis alérgica inducida por proteínas alimentarias se originan por la inflamación local del colon distal, que causa hematoquecia en neonatos. Puede afectar todo el conducto gastrointestinal y provocar síntomas de emesis intratable, con subsiguientes trastornos metabólicos y choque hipovolémico. El síndrome de enterocolitis inducida por proteínas alimentarias es una alergia no mediada por IgE que suele aparecer en la infancia, con vómito prolongado repetitivo, que inicia entre 1 a 4 horas después de la ingestión de alimentos. La manifestación en adultos suele desencadenarse por el consumo de mariscos. Las enfermedades atópicas afectan del 40-60% de los pacientes con síndrome de enterocolitis inducida por proteínas alimentarias, incluso al 40-50% de quienes padecen enteropatía y proctocolitis inducidas por proteínas alimentarias. Los probióticos (Lactobacillus GG) pueden aliviar los síntomas de proctocolitis alérgica inducida por proteínas alimentarias, al alterar la composición de la microbiota intestinal. El trasplante de microbiota fecal (TMF) puede cambiar la microecología intestinal de manera eficiente comparada con los alimentos o probióticos.
References
Cianferoni A. Non-IgE Mediated Food Allergy. Curr Pediatr Rev 2020; 16 (2): 95-105. doi: 10.2174/1573396315666191031103714.
Zhang S, Sicherer S, Berin MC, Agyemang A. Pathophysiology of Non-IgE-Mediated Food Allergy. Immunotargets Ther 2021; 29 (10): 431-446. doi: 10.2147/ITT.S284821.
Mennini M, Fierro V, Di Nardo G, Pecora V, et al. Microbiota in non-IgE-mediated food allergy. Curr Opin Allergy Clin Immunol 2020; 20 (3): 323-328.
Tordesillas L, Berin MC, Sampson HA. Immunology of Food Allergy. Immunity 2017; 47 (1): 32-50. doi: 10.1016/j.immuni.2017.07.004.
Labrosse R. Graham F, Caubet JC. Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update. Nutrients 2020. 2020; 12 (7): 2086. doi: 10.3390/nu12072086.
Nowak-Węgrzyn A, Chehade M, Groetch ME, Spergel JM, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Commitee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2017; 139 (4): 1111-1126. doi: 10.1016/j.jaci.2016.12.966. Epub 2017 Feb 4.
Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child 2009; 94: 425-428.
Sopo SM, Giorgio V, Iacono ID, Novembre E, et al. A multicenter retrospective study of 66 Italian children with food protein-induced enterocolitis syndrome: different management for different phenotypes. Clin Exp Allergy 2012; 42: 1257-65. doi: 10.1111/j.1365-2222.2012.04027.x.
Mehr S, Frith K, Barnes EH, Campbell DE, et al. Food protein–induced enterocolitis syndrome in Australia: A population-based study, 2012–2014. J. Allergy Clin Immunol 2017; 140: 1323-1330.
Rostami MN; Douraghi M, Mohammadi AM, Nikmanesh B. Altered serum pro-inflammatory cytokines in children with Down’s syndrome. Eur Cytokine Netw 2012; 23: 64-67. doi: 10.1684/ecn.2012.0307.
Tan JA, Smith WB. Non-IgE-mediated gastrointestinal food hypersensitivity syndrome in adults. J Allergy Clin Immunol Pract 2014; 2 (3): 355-7.
Kimura M, Ito Y, Shimomura M, Morishita H, et al. Cytokine profile after oral food challenge in infants with food protein-induced enterocolitis syndrome. Allergol Int. 2017; 66(3): 452-457. doi: 10.1016/j.alit.2016.12.001.
Caubet JC, Szajewska H, Shamir R, Nowak-Węgrzyn A. Non-IgE -mediated gastrointestinal food allergies in children. Pediatr Allergy Immunol. 2017; 28(1): 6-17.
Goswami R, Blazquez AB, Kosoy R, Rahman A, et al. Systemic innate immune activation in food protein-induced enterocolitis syndrome. J Allergy Clin Immunol 2017; 139 (6): 1885-1896.
Morita H, Nomura I, Orihara K, Yoshida K, et al. Antigen specific T-cell responses in patients with non-IgE-mediated gastrointestinal food allergy are predominantly skewed to T(H)2. J Allergy Clin Immunol 2013; 131: 590-592.
Mori F, Barni S, Cianferoni A, Pucci N, et al. Cytokine expression in CD3+ cells in an infant with food protein-induced enterocolitis syndrome (FPIES): case report. Clin Dev Immunol. 2009; 2009: 679381. doi: 10.1155/2009/679381.
Adel-Patient K, Lezmi G, Castelli FA, et al. Deep analysis of immune response and metabolic signature in children with food protein induced enterocolitis to cow’s milk. Clin Transl Allergy 2008; 8 (38). doi: 10.1186/s13601-018-0224-9. eCollection 2018.
Berin MC, Lozano-Ojalvo D, Agashe C, Baker MG, et al. Acute FPIES reactions are associated with an IL-17 inflammatory signature. J Allergy Clin Immunol 2021; 148 (3): 895-901.
Katz Y, Goldberg MR, Rajuan N, Cohen A, et al. The prevalence and natural course of food protein-induced
enterocolitis syndrome to cow’s milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011; 127: 647-653.e1-3. doi: 10.1016/j.jaci.2010.12.1105.
Boyer J, Scuderi V, Keene NH. Comparison of the gut microbiome between food protein-induced enterocolitis syndrome (FPIES) infants and allergy-free infants. Ann Allergy Asthma Immunol 2017; 119: e3.
Baker MG, Berin MC, Sicherer S. Update on Food Protein-Induced Enterocolitis Syndrome (FPIES). Curr Allergy Asthma Rep 2022; 22 (10): 113-122.
Hofmann NV, Ahmed A, Fortunato JE. Food protein-induced enterocolitis syndrome: dynamic relationship among gastrointestinal symptoms, immune response, and the autonomic nervous system. Ann Allergy Asthma Immunol 2021; 126 (5): 498-505.
Ono HK, et al. Histamine release from intestinal mast cells induced by staphylococcal enterotoxin A (SEA) evokes vomiZng refex in common marmoset. PLoS Pathog 2019; 15 (5): e1007803.
Jarvinen K, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome: current management strategies. J Allergy Clin Immunol Pract 2013; 1 (4): 317-22. doi: 10.1016/j.jaip.2013.04.004.
Miceli Sopo S, Gelsomino M, Rivep S, Del Vescovo E. Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions. Medicina 2019; 55 (6): 216.
Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol 2005; 115: 149-56.
Burks AW, Tang M, Sicherer S, Muraro A, et al. ICON: food allergy. J Allergy Clin Immunol. 2012; 129: 906-20.
Miceli Sopo S, Greco M, Monaco S, Tripodi S, Calvani M. Food protein-induced enterocolitis syndrome, from practice to theory. Exp Rev Clin Immunol. 2013; 9: 707-15. doi: 10.3390/medicina55060216.
Gonzalez-Delgado P, Ruano-Zaragoza M, Gutierrez A, Lopez F, et al. Chronic adult food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol. 2020; 125 (6): 716-7. doi: 10.1016/j.anai.2020.08.009.
Kuitunen P, Visakorpi JK, SavilahZ E, Pelkonen P. Malabsorption syndrome with cow’s milk intolerance. Clinical findings and course in 54 cases. Arch Dis Child 1975; 50 (5): 351-356.
Barni S, Giovannini M, Mori F. Epidemiology of non-IgE-mediated food allergies: what can we learn from that? Curr Opin Allergy Clin Immunol 2021; 21(2): 188-194.
Beyer K, Castro R, Birnbaum A, Benkov K, et al. Human milk specific mucosal lymphocytes of the gastrointestinal tract display a TH2 cytokine profile. J Allergy Clin Immunol 2002; 109(4): 707-713.
Kokkonen J, HaapalahZ M, Laurila K, Karbunen TJ, et al. Cow’s milk protein sensitive enteropathy at school age. J Pediatr 2001; 139 (6): 797-803.
Savilahti JE. Food-induced malabsorption. J Pediatr Gastroenterol Nutr Pediatr Gastroenterol 2000; 30: S61-S66. doi: 10.1097/00005176-200001001-00010.
Meyer R, Lozinsky AC, Fleischer DM, Vieira MC, et al. Diagnosis and management of Non-IgE gastrointestinal allergies in breassed infants – an EAACI position paper. Allergy. 2020; 75: 14-32. doi: 10.1111/all.13947.
American College of Allergy, Asthma, and Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006; 96 (Suppl 2): S1-S68.
Martin VM, Virkud YV, Phadke NA, et al. Increased IgE-mediated food allergy with food protein-induced allergic proctocolitis. Pediatrics 2020; 146 (3).
Connors L, O’Keefe A, Rosenfield L, Kim H. Non-IgE-mediated food hypersensitivity. Allergy Asthma Clin Immunol. 2018;14 (Suppl 2): 56. doi: 10.1186/s13223-018-0285-2.
Martin VM, Virkud YV, Seay H, et al. Prospective assessment of pediatrician-diagnosed food protein-induced allergic proctocolitis by gross or occult blood. J Allergy Clin Immunol Pract 2020; 8 (5): 1692-1699.e1.
Ozen A, Gulcan EM, Ercan Saricoban H, Ozkan F, et al. Food protein-induced non-immunoglobulin E-mediated allergic colitis in infants and older children: what cytokines are involved? Int Arch Allergy Immunol 2015; 168 (1): 61-68.
Erdem SB, Nacaroglu HT, Karaman S, et al. Tolerance development in food protein induced allergic proctocolitis: single center experience. Allergol Immunopathol 2017; 45: 212-219.
Kumagai H, Maisawa S, Tanaka M, et al. Intestinal microbiota and secretory immunoglobulin A in feces of exclusively breast-fed infants with blood-streaked stools. Microbiol Immunol 2012; 56: 657-663.
Mennini A, Fiocchi AG, Cafarop A, Montesano M, et al. Food protein-induced allergic proctocolitis in infants: Literature review and proposal of a management protocol. World Allergy Organ J 2020; 13: 100-471. doi: 10.1016/j.waojou.2020.100471.
Baldassarre ME, Laforgia N, Fanelli M, et al. Lactobacillus GG improves recovery in infants with blood in the stools and presumptive allergic colitis compared with extensively hydrolyzed formula alone. J Pediatr 2010; 156: 397-401.
Liu SX, Li YH, Dai WK, et al. Fecal microbiota transplantation induces remission of infantile allergic colitis through gut microbiota re-establishment. World J Gastroenterol 2017; 23: 8570-8581.
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