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What do allergists in practice need to know about non–IgE-mediated food allergies

2019; Elsevier BV; Volume: 122; Issue: 6 Linguagem: Inglês

10.1016/j.anai.2019.03.025

1534-4436

Sam Mehr, Terri Brown‐Whitehorn,

Eosinophilic Disorders and Syndromes

Key Messages•Non-IgE food allergic conditions have the ability to cause significant morbidity and are being increasingly recognized.•Food protein–induced allergic proctocolitis (FPIAP) is a benign self-limited disorder that presents in otherwise healthy infants with bloody stools. Some centers are advocating observation without initial dietary intervention.•Food protein enteropathy (FPE) is now an uncommon disorder that is often caused by a single food and associated with iron deficiency, hypoalbuminemia, and growth failure.•Eosinophilic esophagitis (EoE) is a chronic disorder that can present at any age, and is treatable, but is associated with lower rates of self-resolution.•Acute food protein–induced enterocolitis syndrome (FPIES) is often caused by a single food, usually not accompanied by fever nor by significant elevations in C-reactive protein, and overall has a good prognosis.•Chronic FPIES is rare, has a similar clinical presentation to FPE, but is differentiated by the presence of acute FPIES when the food trigger is reintroduced after a brief period of exclusion.InstructionsCredit can now be obtained, free for a limited time, by reading the review article in this issue and completing all activity components. Please note the instructions listed below:•Review the target audience, learning objectives and all disclosures.•Complete the pre-test.•Read the article and reflect on all content as to how it may be applicable to your practice.•Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 CreditTM. Minimum passing score on the post-test is 70%.•Approximately 4-6 weeks later you will receive an online outcomes assessment regarding your application of this article to your practice. Once you have completed this assessment, you will be eligible to receive MOC Part II credit from the American Board of Allergy and Immunology.Overall PurposeParticipants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices.Learning ObjectivesAt the conclusion of this activity, participants should be able to:•Recognize differences in clinical presentation and management among FPIAP, FPE and FPIES.•Describe change in diagnostic criteria for eosinophilic esophagitis.Release Date: June 1, 2019Expiration Date: May 31, 2021Target AudiencePhysicians involved in providing patient care in the field of allergy/asthma/immunologyAccreditationThe American College of Allergy, Asthma & Immunology (ACAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.DesignationThe American College of Allergy, Asthma & Immunology (ACAAI) designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Disclosure PolicyAs required by the Accreditation Council for Continuing Medical Education (ACCME) and in accordance with the American College of Allergy, Asthma and Immunology (ACAAI) policy, all CME planners, presenters, moderators, authors, reviewers, and other individuals in a position to control and/or influence the content of an activity must disclose all relevant financial relationships with any commercial interest that have occurred within the past 12 months. All identified conflicts of interest must be resolved and the educational content thoroughly vetted for fair balance, scientific objectivity, and appropriateness of patient care recommendations. It is required that disclosure be provided to the learners prior to the start of the activity. Individuals with no relevant financial relationships must also inform the learners that no relevant financial relationships exist. Learners must also be informed when off-label, experimental/investigational uses of drugs or devices are discussed in an educational activity or included in related materials. Disclosure in no way implies that the information presented is biased or of lesser quality. It is incumbent upon course participants to be aware of these factors in interpreting the program contents and evaluating recommendations. Moreover, expressed views do not necessarily reflect the opinions of ACAAI.Disclosure of Relevant Financial RelationshipsAll identified conflicts of interest have been resolved. Any unapproved/investigative uses of therapeutic agents/devices discussed are appropriately noted.Planning Committee•Larry Borish, MD, Consultant, Fees/Contracted Research: AstraZeneca, Novartis, Regeneron, Teva•Mariana C. Castells, MD, PhD, has no relevant financial relationships to disclose•Anne K. Ellis, MD, MSc, Advisory Board/Speaker, Honorarium: Alk-Abello, Aralez, AstraZeneca, Boehringer Ingelheim, Circassia Ltd., GlaxoSmithKline, Meda, Merck, Novartis, Pediapharma, Pfizer, Sanofi, Takeda; Research, Grants: Bayer, Circassia Ltd., Green Cross Pharmaceuticals, GlaxoSmithKline, Merck, Novartis, Pfizer, Sanofi, Sun Pharma•Mitchell Grayson, MD, Advisory Board, Honorarium: AstraZeneca, Genentech, Novartis•Matthew Greenhawt, MD, Advisory Board/Consultant/Speaker, Fees/Honorarium: Allergenis, Aquestive, DVB Technologies, Genentech, Intrommune, Kaleo, Nutricia, Sanofi/Genzyme•William Johnson, MD, has no relevant financial relationships to disclosure•Donald Leung, MD, Chair, DSMC/ Consultant, Fees: AbbVie, Aimmune, Regeneron, Sanofi-Aventis Pharma; Research, Grants: Incyte Corp, Pfizer•Jay Lieberman, MD, Advisory Board/Author/Speaker, Honorarium/Contracted Research: Aimmune, ALK-Abello, Aquestive Therapeutics, DBV Technologies•Gailen D. Marshall, Jr, MD, PhD, has no relevant financial relationships to disclose•Anna Nowak-Wegrzyn, MD, Chair, Honorarium/Contracted Research: Alk-Abello, Merck; Consultant, Fees: LabCorp; Co-Investigator, Fees: Sanofi Aventis; Private Investigator, Contracted Research/Honorarium: Abbott, Astellas Pharma, Danone Nutricia, DBV Technologies, Nestle•John J. Oppenheimer, MD, Consultant, Fees: DBV Technologies, GlaxoSmithKline, Sanofi, Teva; Adjudication, Fees: MedImmune•Jonathan M. Spergel, MD, PhD, Advisory Board/Consultant/Research, Fees/Contracted Research/Honorarium: Aimmune Therapeutics, DBV Technologies, Regeneron, Pfizer; Speaker, Honorarium: AbbottAuthorThe following individuals have no relevant financial relationships to disclose:•Sam Mehr, MBBS, BMedSci, FRACP, FRCPA•Terri Brown-Whitehorn, MDRecognition of Commercial Support: This activity has not received external commercial support.Copyright Statement: 2015-2019 ACAAI. All rights reserved.CME Inquiries: Contact the American College of Allergy, Asthma & Immunology at [email protected] or 847-427-1200. •Non-IgE food allergic conditions have the ability to cause significant morbidity and are being increasingly recognized.•Food protein–induced allergic proctocolitis (FPIAP) is a benign self-limited disorder that presents in otherwise healthy infants with bloody stools. Some centers are advocating observation without initial dietary intervention.•Food protein enteropathy (FPE) is now an uncommon disorder that is often caused by a single food and associated with iron deficiency, hypoalbuminemia, and growth failure.•Eosinophilic esophagitis (EoE) is a chronic disorder that can present at any age, and is treatable, but is associated with lower rates of self-resolution.•Acute food protein–induced enterocolitis syndrome (FPIES) is often caused by a single food, usually not accompanied by fever nor by significant elevations in C-reactive protein, and overall has a good prognosis.•Chronic FPIES is rare, has a similar clinical presentation to FPE, but is differentiated by the presence of acute FPIES when the food trigger is reintroduced after a brief period of exclusion. Credit can now be obtained, free for a limited time, by reading the review article in this issue and completing all activity components. Please note the instructions listed below:•Review the target audience, learning objectives and all disclosures.•Complete the pre-test.•Read the article and reflect on all content as to how it may be applicable to your practice.•Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 CreditTM. Minimum passing score on the post-test is 70%.•Approximately 4-6 weeks later you will receive an online outcomes assessment regarding your application of this article to your practice. Once you have completed this assessment, you will be eligible to receive MOC Part II credit from the American Board of Allergy and Immunology. Overall Purpose Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices. Learning Objectives At the conclusion of this activity, participants should be able to:•Recognize differences in clinical presentation and management among FPIAP, FPE and FPIES.•Describe change in diagnostic criteria for eosinophilic esophagitis. Release Date: June 1, 2019 Expiration Date: May 31, 2021 Target Audience Physicians involved in providing patient care in the field of allergy/asthma/immunology Accreditation The American College of Allergy, Asthma & Immunology (ACAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Designation The American College of Allergy, Asthma & Immunology (ACAAI) designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure Policy As required by the Accreditation Council for Continuing Medical Education (ACCME) and in accordance with the American College of Allergy, Asthma and Immunology (ACAAI) policy, all CME planners, presenters, moderators, authors, reviewers, and other individuals in a position to control and/or influence the content of an activity must disclose all relevant financial relationships with any commercial interest that have occurred within the past 12 months. All identified conflicts of interest must be resolved and the educational content thoroughly vetted for fair balance, scientific objectivity, and appropriateness of patient care recommendations. It is required that disclosure be provided to the learners prior to the start of the activity. Individuals with no relevant financial relationships must also inform the learners that no relevant financial relationships exist. Learners must also be informed when off-label, experimental/investigational uses of drugs or devices are discussed in an educational activity or included in related materials. Disclosure in no way implies that the information presented is biased or of lesser quality. It is incumbent upon course participants to be aware of these factors in interpreting the program contents and evaluating recommendations. Moreover, expressed views do not necessarily reflect the opinions of ACAAI. Disclosure of Relevant Financial Relationships All identified conflicts of interest have been resolved. Any unapproved/investigative uses of therapeutic agents/devices discussed are appropriately noted. Planning Committee•Larry Borish, MD, Consultant, Fees/Contracted Research: AstraZeneca, Novartis, Regeneron, Teva•Mariana C. Castells, MD, PhD, has no relevant financial relationships to disclose•Anne K. Ellis, MD, MSc, Advisory Board/Speaker, Honorarium: Alk-Abello, Aralez, AstraZeneca, Boehringer Ingelheim, Circassia Ltd., GlaxoSmithKline, Meda, Merck, Novartis, Pediapharma, Pfizer, Sanofi, Takeda; Research, Grants: Bayer, Circassia Ltd., Green Cross Pharmaceuticals, GlaxoSmithKline, Merck, Novartis, Pfizer, Sanofi, Sun Pharma•Mitchell Grayson, MD, Advisory Board, Honorarium: AstraZeneca, Genentech, Novartis•Matthew Greenhawt, MD, Advisory Board/Consultant/Speaker, Fees/Honorarium: Allergenis, Aquestive, DVB Technologies, Genentech, Intrommune, Kaleo, Nutricia, Sanofi/Genzyme•William Johnson, MD, has no relevant financial relationships to disclosure•Donald Leung, MD, Chair, DSMC/ Consultant, Fees: AbbVie, Aimmune, Regeneron, Sanofi-Aventis Pharma; Research, Grants: Incyte Corp, Pfizer•Jay Lieberman, MD, Advisory Board/Author/Speaker, Honorarium/Contracted Research: Aimmune, ALK-Abello, Aquestive Therapeutics, DBV Technologies•Gailen D. Marshall, Jr, MD, PhD, has no relevant financial relationships to disclose•Anna Nowak-Wegrzyn, MD, Chair, Honorarium/Contracted Research: Alk-Abello, Merck; Consultant, Fees: LabCorp; Co-Investigator, Fees: Sanofi Aventis; Private Investigator, Contracted Research/Honorarium: Abbott, Astellas Pharma, Danone Nutricia, DBV Technologies, Nestle•John J. Oppenheimer, MD, Consultant, Fees: DBV Technologies, GlaxoSmithKline, Sanofi, Teva; Adjudication, Fees: MedImmune•Jonathan M. Spergel, MD, PhD, Advisory Board/Consultant/Research, Fees/Contracted Research/Honorarium: Aimmune Therapeutics, DBV Technologies, Regeneron, Pfizer; Speaker, Honorarium: Abbott Author The following individuals have no relevant financial relationships to disclose:•Sam Mehr, MBBS, BMedSci, FRACP, FRCPA•Terri Brown-Whitehorn, MD Recognition of Commercial Support: This activity has not received external commercial support. Copyright Statement: 2015-2019 ACAAI. All rights reserved. CME Inquiries: Contact the American College of Allergy, Asthma & Immunology at [email protected] or 847-427-1200.