slideshow


Tuesday, May 10, 2011

FPIES as a Garden, a personal account by Amanda



 Spring is certainly upon us and thank goodness! I thought I would never see anything but a white lawn staring back at me whenever I looked out of our windows! We haven't quite lived in our house for a year now and there is a TON of yard work to do, thanks to the lovely prior owners. SIGH. I do like working in the yard, creating something out of this very messy blank canvas that is out there in the back yard. As I was digging, planting and weeding today, I couldn't stop thinking about how similar all of this work was to our everyday work with building B's diet in a safe and (hopefully) interesting way.

One of the previous owners (I am guessing YEARS ago) seems to have been something of a gardener. I keep unearthing randomly placed flowers and shrubs, and slowly as we clean things up, I see that there were once gardens in these places. Hostas, hybrid lillies, ornamental shrubs. . . I keep finding these in the strangest of places. Last fall, I dug up and transplanted about 40 (!!!!) lillies from various spots in the gardens and yard. There was a huge mass of them in one garden in particular-- becoming root bound and unhealthy. So I separated them, gave them new homes, and now in the spring I have these huge new plants, flourishing. Plants that I was hesitant about keeping in the fall have now become beautiful additions to the garden and are thriving.

With B's FPIES "journey," we have seen a lot of parallels. We are constantly tending the garden, adding in new "plants" and hoping that they will thrive and that the garden itself will improve from the additions. And when the new "plants" fail, we till the soil and try again once the ground is smooth again and ready for planting.  Zantac and probiotics control the weeds and keep the garden as free of harmful pests as possible. And the biggest parallel-- uncovering surprises. As I dig and reshape our yard (with the help of N of course and with the encouragement of B from her station in the sandbox), I find treasure in the compost heap (healthy, beautiful plants), treasure in flowers that I was sure would not winter over (but did!!! Even despite our snowy months!). Sure, most "common" toddler foods don't affect the B garden positively (dairy, wheat, etc), but we have found treasure in things like quinoa, mango, and coconut, foods I never would have expected to be staples in the diet of a toddler. And the hidden surprise of a food that was only tolerated in tiny amounts last year now becoming a staple in B's diet. Now being tolerated by her body, now being welcome in her garden.

Of course, like the garden, tending to our children's FPIES is constant work. But there are rewards amongst the weeds, amongst the compost. And there are surprises! And there is, even in the tiniest ways, eventual growth. So I will, as the rest of you will I am sure, continue to dig, continue to shape and continue to nurture, in hopes that one day, we will see the ultimate growth that we are hoping for, for her body to begin to tolerate more than it rejects, for my beautiful flower to be free of the threats of FPIES.

Monday, May 2, 2011

What is a Non-IgE Food Allergy? By the PIC Team


A Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food that are either IgE or Non-IgE mediated.  Food Allergy is now being increasingly recognized as classified, IgE and/or Non-IgE mediated.

IgE stands for Immunoglobin E, a measurable antibody producing immune response to a food protein.  Symptoms are immediate onset (0-2hrs within ingestion) and can include, but not limited to: hives, sneezing, wheezing, itching, red eyes, throat swelling, allergic asthma, and severe reactions can include rapid heart rate, low blood pressure, anaphylaxis (see table below).   The most common ("top 8") food allergens include: eggs, milk, peanut, tree nut, wheat, shellfish, and soy but are not limited to these foods,  any food with a protein can elicit an allergic reaction.  Also included in the immediate immune response is Oral Allergy Syndrome (OAS) and some components of Eosinophilic disorders (EGID).

A Non-IgE Allergy is cell-mediated (vs.antibody) and defined by a delayed response of the immune system, typically involving the gut.  No measurable antibodies are produced, symptoms are delayed (2+hours from ingestion) and include, but not limited to: sneezing, itching, runny nose, asthma, reflux, colic, abdominal pain, nausea, vomiting and diarrhea, and severe reactions can include lethargy, hypotension, and shock (see table below).  Like IgE allergies, the "Top 8" are included but are not limited in Non-IgE food allergies as any food protein can elicit this response.  Diagnosis included in this immune response are: Milk/Soy Protein intolerance, Multiple Food Protein Intolerance, Food Protein-Induced Procolitis, Food Protein Induced Enterocolits, Food Protein Enteropathy, Celiac Disease, and Eosinophilic Disorders.



IgE FOOD ALLERGY:
(Typical food allergy)
Immediate onset reactions
Mediated by production of Immunoblogin E antibodies in response to a food, usually a protein.
Common Conditions*:
1.IgE food allergy (ie egg, milk, peanut, tree nut, soy, wheat, shell fish…)
2.Eosinophilic Disorders
3.Oral Allergy Syndrome
 *list is not inclusive, please see your doctor for any symptoms/diagnosis

Common Respiratory Symptoms:
·Sneezing, runny nose, congestion, hay fever
·Shortness of breath
·Throat swelling
·Cough
·Allergic asthma
·Pink eye/eye swelling

COMMON GI SYMPTOMS:
  • Nausea/Vomiting/Diarrhea
  • Cramping abdominal pain
  • Reflux/Difficulty swallowing
  • Swelling (tongue,lips,face)
  • Itching/swelling of the tongue, lips, mouth
  • Dizziness
  • Fainting
Severe reactions (anaphylaxis) can be life threatening and require immediate medical attention and can include:
  • Itching or tightness in the throat
  • Difficulty breathing
  • Wheezing/coughing
  • Rapid heart rate
  • Low blood pressure
  • Loss of consciousness
Symptoms usually occur within minutes to 1-2 hours after ingesting the food.

Common skin symptoms:
·Eczema
·Hives
·Rashes (dermatitis)
Diagnostic Tests:
·RAST (serum IgE)
·Skin Prick Testing
·EE requires endoscopy




NON- IgE FOOD ALLERGY: (PROTEIN INTOLERANCE)
Delayed onset reactions
Mediated by non-IgE antibodies and/or cellular immune responses to a food-protein.
Common conditions*:
1.Milk/Soy Protein Intolerance
2.Multiple Food Protein Intolerance
3.Food protein-Induced Allergic Protocolitis
4.Food Protein Induced Enterocolitis Syndrome
5.Food Protein Enteropathy
6.Celiac Disease (also auto-immune)
7.Eosinophilic Disorders (also IgE)
*list is not inclusive, please see your doctor for any symptoms/diagnosis


Common Respiratory Symptoms:
·Non-allergic sneezing, congestion, runny nose
·Non-atopic cough, asthma
·Recurrent or chronic sinus inflammation/infections
·Reflux disease
·Recurrent ear infections
·Eye swelling
·Enlarged adenoids
  
COMMON GI SYMPTOMS
  • Mucus/Blood in Stools
  • Inconsolable and Extended Crying/Colic
  • Disrupted Sleep
  • Malabsorption/Vitamin Deficiency
  • "Spit-up" an hour+ after feeding
  • Sulfur/sour smelling stools
  • Diarrhea and/or constipation
  • Red ring around bottom (diaper) 
  • Peeling diaper rash
  • Gas/wind
  • Mouth itching
  • Dysbiosis
Symptoms can occur hours to days after ingesting the food.

Severe reactions can be life threatening (FPIES) and require immediate medical attention and can include:
  • Loss of appetite
  • Violent/forceful/projectile vomiting
  • Lethargy
  • Diarrhea
  • Dehydration
  • Low body temp or fever
  • Low blood pressure
  • Shock
Common skin symptoms:
·Eczema
·Rashes/flushing
·Itchy skin
·Diaper rash.
  
Diagnostic Tests:
·Medical history
·Food elimination and challenge
·Endoscopy/colonoscopy
 Atopy Patch Testing


References:
  1. Guidelines for Diagnosis and Management of Food Allergy in the United States (2010)
  2. Medical Journal Article on Protein Intolerance (April 2010)
  3. Nonimmunoglobin E-Mediated Immune Reactions to Foods by Dr.Spergel (2006)
  4. Non-Ige Food Allergy by Dr. Jyonouchi (2008)
  5. Food Allergy: Review, Classification and Diagnosis by Dr.Spergel & Dr.Cianferoni (2009)