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Old 11-28-2012, 11:33 AM
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Default Potential crib death link ?

Sharing an article published from Medscape. Highlights FPIES an underdiagnosed condition which my daughter has. Since her first reaction I have been terrified of her reacting while sleeping, since lethargy is one of the major reactions. Finally, an article that links that this condition could contribute to crib death. I have bolded that piece. Just thought I would share this.

I tried to link the publication but you need to log in to Medscape first, something I realize not everyone can do. Instead, I attached the article here:


ANAHEIM, California — Food protein-induced enterocolitis syndrome (FPIES) was triggered by orange juice in a 2-year-old boy, according to a poster presented here at the American College of Allergy, Asthma & Immunology 2012 Annual Scientific Meeting.

FPIES and its triggers (most commonly cow's milk, rice, and soy) can be difficult to diagnose, lead researcher Tara Federly, MD, a fellow at the Children's Mercy Hospital and the University of Missouri in Kansas City, told Medscape Medical News.

FPIES is not mediated by immunoglobulin (Ig)E, "so it's not the immediate hypersensitivity reaction that you see with peanut or milk or other allergy," Dr. Federly explained. "The exact mechanism is not known, but it's basically an inflammation of the GI tract that is triggered by certain foods. The interesting thing is that it happens hours after ingestion, instead of being a more immediate IgE-mediated reaction," she said.

In the case reported by Dr. Federly and her colleagues, which they describe as the first report of orange juice being the causative agent in FPIES, a 2-year-old boy presented with lethargy and severe vomiting that required hospitalization and the administration of intravenous fluids. This occurred on 5 occasions.

The episodes occurred without associated rash, angioedema, respiratory symptoms, fever, or contact with other sick children.

Each time, "the emergency department thought that he had viral gastroenteritis, and he returned to normal after intravenous fluid replacement," Dr. Federly reported.

On further questioning, the child's mother implicated orange juice as an apparent trigger because the reaction usually occurred a couple of hours after he drank it.

The possibility of an IgE-mediated food allergy was ruled out on the basis of negative skin-prick testing to orange extract and fresh orange juice. In addition, IgE specific to orange was less than 0.1 kU/L, Dr. Federly said.

The researchers performed an FPIES oral food challenge, using the recommended total challenge dose of 0.06 g of protein/kg divided into 3 feedings over 45 minutes.

The intended duration of observation was 4 hours, but within 90 minutes of the final dose, the child began vomiting every 10 to 15 minutes for 2 hours. He did not develop urticaria, rhinorrhea, wheezing, or other symptoms of anaphylaxis.

His absolute neutrophil count was elevated, from 1920 cells/ÁL to 3420 cells/ÁL.

The child became tachycardic and lethargic after his vomiting episodes and was given normal saline. After vigorous hydration, he responded very well and returned to normal.

Other Fruits Implicated

"This response goes along with FPIES," Dr. Federly said.

"Other fruits have been implicated in FPIES, such as apple, pear, and banana, but not orange juice. When he stopped eating oranges, he had resolution of his vomiting episodes," she explained.

The message for physicians is to think about the possibility of FPIES when a child comes in with recurrent episodes of vomiting and dehydration, she said.

Again, "the most typical triggers would be milk, soy, and rice, but you need to think of unusual cases, such as fruit and more solid foods. These kids should be seen by an allergist.... Doing a challenge in the clinic is the best way to determine if it is really FPIES," she noted.

"Not an Allergy"

Jay Portnoy, MD, professor of pediatrics at the University of Missouri and Mercy Children's Hospital, who was not part of the study, told Medscape Medical News that FPIES is a relatively new syndrome.

"Kids can die from [FPIES]. The reaction is delayed. It happens an hour or 2 after eating the food, so the parents don't always know what food it was; they don't even associate it with a food. It usually happens in children less than 1 year of age, young infants, so this might be responsible for crib death," Dr. Portnoy said.

"The important thing is that allergy testing doesn't help identify FPIES because it's not an allergy; it's something else, but we don't quite know what it is. It is important to be aware that this syndrome exists and that unusual foods not usually linked to food allergy can be associated with it," he said.

Dr. Federly and Dr. Portnoy have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2012 Annual Scientific Meeting: Abstract P261. Presented November 11, 2011.

Last edited by SilverSabre25; 11-28-2012 at 11:39 AM. Reason: link issue
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Old 11-28-2012, 11:40 AM
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I made it bigger for you so it's easier to read
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Old 11-28-2012, 12:10 PM
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wow...I'm not sure what to say...

It's interesting that it usually happens in children under 1 year of age, althought the example they use is a 2 year old boy.

My question is, does the child have to injest the food/drink themselves, or would a breast-fed child have the same issue if MOM ate/drank the trigger?

SIDS is most likely in children under 6 months, and most children aren't taking anything but breast milk until then nowadays, although rice cereal is traditionally introduced first (something I know NannyDE is capaigning against).
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Old 11-28-2012, 01:03 PM
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Quote:
Originally Posted by Heidi View Post
wow...I'm not sure what to say...

It's interesting that it usually happens in children under 1 year of age, althought the example they use is a 2 year old boy.

My question is, does the child have to injest the food/drink themselves, or would a breast-fed child have the same issue if MOM ate/drank the trigger?

SIDS is most likely in children under 6 months, and most children aren't taking anything but breast milk until then nowadays, although rice cereal is traditionally introduced first (something I know NannyDE is capaigning against).

From what I've read it's unlikely to trigger through breastmilk, usually the trigger has to be consumed directly.

I know many many pediatricians now days are recommending starting solids around 3-4 months of age. Heck, my food program has entry spots starting when a child is only 4 months old and multiple solids are *required* the day the child hits 8 months.
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Old 11-28-2012, 01:20 PM
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I think the two year old was used in this article because of orange juice being the trigger which until this instance wasnot a known trigger.

My daughter reacted to foods through my breastmilk however the severity of reaction was less as the food protiens are more broken down in breastmilk.

Also, my daughters first and worst trigger is rice and that has been very "typically" the first trigger since it is often the first food.

And yes the age at which the child eats its first cereal or first food varies however the severity of the reaction in these kids continues long past the 6month age span. My dd has had very severe reactions in which she has been cold, limp, ashy, lethargic after eating something. Had I fed her this food at lunch and then put her to nap I wouldnt have been as able to notice these symptoms. Just the reason I thought to post the info.
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Old 11-28-2012, 01:25 PM
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And since milk and soy are the most common formulas it intrigues me to think that possibly children switching to formula as they enter daycare or switching to MORE formula if parent is unable to nurse as much or pump could contribute to a silent crih death.

Since there is limited research on FPIES and all FPIES kids react differently there can be all different reactions, to different foods, in differing quantities.

Just makes me wonder.
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Old 11-28-2012, 01:38 PM
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Very interesting article. I have two kids right now with food allergies, one only 8 months old with a milk allergy. Another former family has been diagnosed with Celiacs.

Here in MN, providers are really up against it with Safe Sleep Practices and SIDS; The Child Mortality Review Panel and their recommendations will certainly change our business lives if they are passed.

When you read and article like this, you have to wonder if something like this and other things beyond our control are coming into play. Reduced ratios and increased training hours aren't going to affect things like this.

Quote:
Originally Posted by Willow View Post
I know many many pediatricians now days are recommending starting solids around 3-4 months of age. Heck, my food program has entry spots starting when a child is only 4 months old and multiple solids are *required* the day the child hits 8 months.
I have a dcg, she was on formula and only formula until she was nearly 8 months old. Grandpa is her pediatrician and was totally fine with it, as were mom and dad. He said she'll let you know when she needs more.

My fp sponsor disallowed my claim for her every single month because I wasn't feeding her the 'required' components...even though Grandpa/Dr and Mom both wrote letters requesting exemption because the Modified Diet Statement didn't really cover it.

It really bugged me that the parents/doctor couldn't make choices for their daughter when she was perfectly happy, healthy and progressing normally.
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Old 11-28-2012, 04:56 PM
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Quote:
Originally Posted by DCMom View Post
Very interesting article. I have two kids right now with food allergies, one only 8 months old with a milk allergy. Another former family has been diagnosed with Celiacs.

Here in MN, providers are really up against it with Safe Sleep Practices and SIDS; The Child Mortality Review Panel and their recommendations will certainly change our business lives if they are passed.

When you read and article like this, you have to wonder if something like this and other things beyond our control are coming into play. Reduced ratios and increased training hours aren't going to affect things like this.



I have a dcg, she was on formula and only formula until she was nearly 8 months old. Grandpa is her pediatrician and was totally fine with it, as were mom and dad. He said she'll let you know when she needs more.

My fp sponsor disallowed my claim for her every single month because I wasn't feeding her the 'required' components...even though Grandpa/Dr and Mom both wrote letters requesting exemption because the Modified Diet Statement didn't really cover it.

It really bugged me that the parents/doctor couldn't make choices for their daughter when she was perfectly happy, healthy and progressing normally.
But I thought the food program didn't REQUIRE other components until 8 months? I need to check my manual!
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Old 11-28-2012, 05:22 PM
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Quote:
Originally Posted by DCMom View Post

My fp sponsor disallowed my claim for her every single month because I wasn't feeding her the 'required' components...even though Grandpa/Dr and Mom both wrote letters requesting exemption because the Modified Diet Statement didn't really cover it.
How about when the WHO supports that position as well??!

Even my fp rep agrees it's bogus.
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