Vicky Le Blanc
MD, FRCPC
Investigator and Pediatric Allergic, BC Children's Hospital
Journal of Allergy and Clinical Immunology in Practice
Tong, J.Y. and Williams, B.A. and Cameron, S.B. and Chan, E.S. and Cook, V.E. and Dhaliwal, R. and Golding, M.A. and Le Blanc, V. and Morrison, K. and Protudjer, J.L.P. and Soller, L. and Vander Leek, T.K. and Wong, T. and Yatham, K. and Mak, R.
DOI: 10.1016/j.jaip.2025.05.040Allergy Asthma and Clinical Immunology
Le Blanc, V. and Watson, W.T.A.
DOI: 10.1186/s13223-023-00858-4Journal of Allergy and Clinical Immunology in Practice
Le Blanc, V. and Samaan, K. and Paradis, L. and Lacombe-Barrios, J. and Graham, F.J. and Des Roches, A. and B{\'e}gin, P.
DOI: 10.1016/j.jaip.2020.11.027FPIES is a non-IgE mediated food allergy that manifests as delayed gastrointestinal symptoms after ingestion of the culprit food. While FPIES is recognized as a distinct clinical entity, the data regarding FPIES in Canada are sparse. FPIES imposes a burden on patients and their families, as food avoidance and dietary restrictions are necessary and common treatment used for classical IgE mediated allergies such as antihistamines and epinephrine are not viable. Therefore, we wish to develop the first Canadian cohort for FPIES in order to better characterize this disorder in children. Our study will lead to better diagnosis and management of FPIES in the pediatric population.
Consensus guidelines for the management of FPIES are largely based on expert opinion. Diagnosis of FPIES is clinical, and the natural history is poorly defined, with a wide range of median age of tolerance. Management therefore involves strict avoidance of the offending food, with suggested oral food challenges (observed ingestion of the trigger food) with prolonged observation period (4-6 hours) under an allergist supervision 12-18 months after the most recent reaction. Delayed food introduction is a known risk factor for the development of IgE-mediated food allergy in high-risk individuals. One of the risks of the current FPIES management strategy of strict avoidance is the potential development of new IgE-mediated allergy, particularly when the trigger food is also a highly allergenic food. Food ladders have become increasingly utilized in IgE-mediated food allergy to milk and/or egg. A very small number of case studies and case series have also used a ladder approach in non-IgE mediated reactions to egg with success. A ladder/gradual reintroduction approach for patients with non-egg FPIES has not been evaluated in the literature. Given the possible benefit of food ladders and the lack of evidence currently available to guide this introduction, evaluating food ladders for their ability to safely advance the diet in a stepwise fashion for patients with FPIES could provide much-needed evidence-based guidance. We aim to use ladders to evaluate their efficacy and safety in patients with mild to moderate FPIES to milk and/or egg as well as other foods including those known to carry a high risk of IgE-mediated allergy when avoided.
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