La presentazione è in caricamento. Aspetta per favore

La presentazione è in caricamento. Aspetta per favore

Conoscenza della Food Protein-Induced Enterocolitis Syndrome (FPIES) tra i pediatri di famiglia Pasquale Comberiati Clinica Pediatrica Università di Verona.

Presentazioni simili


Presentazione sul tema: "Conoscenza della Food Protein-Induced Enterocolitis Syndrome (FPIES) tra i pediatri di famiglia Pasquale Comberiati Clinica Pediatrica Università di Verona."— Transcript della presentazione:

1 Conoscenza della Food Protein-Induced Enterocolitis Syndrome (FPIES) tra i pediatri di famiglia Pasquale Comberiati Clinica Pediatrica Università di Verona

2 Retrospective study ( ): Rome, Florence, Benevento 66 children, 165 episodes 35 (53%) OFC diagnosed vs 31 (47%) clinically diagnosed Tolerance OFC 1-year after last reaction A multicentre retrospective study of 66 Italian children with FPIES: different management for different phenotypes Sopo MS, CEA 2012; 42:1257 No. of FPIES diagnosis at the 3 centers 18 – 16 – 14 – 12 – 10 – 8 – 6 – 4 – 2 – P <

3 The prevalence and natural course of FPIES to cow’s milk: A large-scale, prospective population based study. Katz Y, JACI 2011; 127:647 Incidence of CM-FPIES vs IgE-CMA % 0.34% 0.5% FPIES (n= 44) IgE-CMA (n= 66) 0.6 – 0.4 – 0.2 – 0 Cohort of 13,019 infant ( ) 44 with CM-FPIES and 66 with IgE-CMA 28 (64%) OFC vs 16 (36%) clinically diagnosed CM-FPIES Incidence

4 FPIES: The diagnosis is often delayed Fiocchi A, Curr Opin Allergy Clin Immunol 2014, 14:246–254 Lack of suspition Lack of suspition No specific diagnostic tests Non-specific presenting symptoms

5 F P I E S ANAPHYLAXISSEPSISGASTROENTERITIS METABOLIC DISORDES PRIMARY IMMUNODEFICIENCY SURGICAL ABDOMINAL CONDITION Differential diagnosis of food protein-induced enterocolitis syndrome (FPIES) Fiocchi A, Curr Opin All Clin Immunol 2014; 14:246

6 Food Protein-Induced Enterocolitis Syndrome (FPIES): 16-Year Experience Mehr S, Pediatrics 2009; 123:e459 Retrospective study ( ) 35 patients66 acute FPIES 35 patients, with 66 acute FPIES Causative foods, clinical features, treatments, and outcomes 1 Episodes 40 – 30 – 20 – 10 – 0 Episodes of Acute FPIES before diagnosis % 29% 20% 26% 2 Episodes 3 Episodes 4 Episodes

7 Food Protein-Induced Enterocolitis Syndrome (FPIES): 16-Year Experience Mehr S, Pediatrics 2009; 123:e459 Abdominal Imaging 40 – 30 – 20 – 10 – 0 Additional investigations of FPIES episodes % 34% 2% 22% 28% Septic evaluation Surgical consultat Laparotomy Retrospective study ( ) 35 patients66 acute FPIES 35 patients, with 66 acute FPIES Causative foods, clinical features, treatments, and outcomes

8 Indagine conoscitiva «FPIES» Questionario «on-line» anonimo Google-drive platform 16 domande risposta multipla 194 Pediatri di famiglia Verona (70%) e Torino (30%) OBIETTIVI E METODI Torino Clinica Pediatrica Università di Verona

9 % 31% 49% 8% Conosco sintomi, diagnosi e terapia Mai sentito parlare Sentito solo parlare Non ho familiarità diagnosi e terapia % Clinica Pediatrica Università di Verona RISULTATI

10 Riso Altri cibi solidi Latte Vaccino Latte di Soia Pesce (Uovo, Cereali, Pollo, Tacchino, Frutta o Verdura) Clinica Pediatrica Università di Verona RISULTATI – Alimenti trigger 20% ha in cura b.ni con FPIES

11 Caubet JC, JACI 2014; 134: Ruffner MA. JACI:In Practice 2013; 1: Mehr S. Pediatrics 2009; 123:e459. Sopo MS. CEA 2012;42: Prevalence of trigger foods in FPIES Cow’s Milk20% Cow’s Milk 67% 44% 20% 67% Fish 12% Fish 1 % 10% 3% 12% Oats Oats 16% 16% 6% - Soy Soy 41% 41% 34% 4% Poultry Poultry 10% 5% 3% 3% Banana Banana 3.5% - 3% - Ruffner (n. 462) Mehr (n. 35) Sopo (n. 66) Egg Egg 11% 3% - 6% Rice19%22% 40% Rice 19% 22% 40% 4% Caubet (n. 160)

12 Clinica Pediatrica Università di Verona % 5% 8% 38% Allergologo Me Medesimo Pediatra Ospedale/ Pronto Soccorso Gastroenterologo % RISULTATI – Chi ha fatto Diagnosi

13 FPIES ACUTA 5 mesi, 2 episodi di vomito profuso, pallore e disidratazione comparsi dopo alcune h assunzione crema di riso. FPIES CRONICA 2 mesi, LF dalla nascita, scarsa crescita ponderale, diarrea cronica con muco ± sangue nelle feci, ± leucocitosi. FPIES CRONICA 3 mesi, LF dalla nascita, scarsa crescita ponderale, diarrea cronica con muco ± sangue nelle feci, persistenza sintomi anche dopo inizio eHCF. 54% 47%23% 13% Clinica Pediatrica Università di Verona RISULTATI – Casi FPIES

14 Clinica Pediatrica Università di Verona RISULTATI – Test Diagnostici 1 70 – 60 – 50 – 40 – 30 – 20 – 10 –0 56% 44% SI NO DIAGNOSI FPIES : Prick Test e/o sIgE devono essere negativi? 24% had positive specific IgE to the FPIES food, ‘‘atypical’’ FPIES Among 160 subjects with FPIES, 24% had positive specific IgE to the FPIES food, which is referred to as ‘‘atypical’’ FPIES Caubet JC, JACI 2014; 134: 382-9

15 Clinica Pediatrica Università di Verona 70 – 60 – 50 – 40 – 30 – 20 – 10 –0 57% 43% SI NO DIAGNOSI FPIES: sempre necessario il TPO? RISULTATI – Test Diagnostici 2 no in vivo in vitro tests to diagnose FPIES There are no in vivo or in vitro tests with demonstrated specificity and sensitivity to diagnose FPIES OFC may not be necessary to make the diagnosis if the history of FPIES is very compelling2 or more reactions with typical symptoms OFC may not be necessary to make the diagnosis if the history of FPIES is very compelling (2 or more reactions with typical symptoms to the same food in a 6-month period and elimination of symptoms when the causative food is removed from the diet) FPIES: Diagnosis Boyce J, J Allergy Clin Immunol 2010;126:S1-S58

16 Clinica Pediatrica Università di Verona RISULTATI – Terapia 1 70 – 60 – 50 – 40 – 30 – 20 – 10 –0 26% 74% SI NO TERAPIA FPIES «ACUTA» : Adrenalina cardine? Oral rehydration fluids (if mild) Intravenous fluids, 20 ml/kg boluses of isotonic saline (if moderate to severe) Metilprednisolone ev, 1mg/kg (max 60-80mg) (if moderate to severe) Epinephrin for hypotension for severe or unresponsive to fluids FPIES: Acute Managment Järvinen KM, JACI in Pract; 2013; 1:317-22

17 Natural history of food protein-induced enterocolitis syndrome (FPIES) Katz Y, Curr Opin All Clin Immunol 2014; 14:229 Around 90% of FPIES patients recover by the age 3–5 years. Recovery from FPIES to solid foods occurs later than FPIES to Cow’s Milk or Soy. Cumulative probability of recovery from CMP-induced FPIES

18 Clinica Pediatrica Università di Verona A quanti mesi dall’ultima FPIES «acuta» consiglieresti la Reintroduzione dell’alimento? Around 90% of FPIES patients recover by the age 3–5 years. Oral Food Challenge is warranted to determine when FPIES has resolved 1st Tolerance-OFC with cow’s milk at months of age. For other foods reports are insufficient, and should be considered for reintroduction to the diet 12–18 months after the last reaction, in a physician- supervised setting FPIES: Long term Managment 6-11mesi 12-18mesi 18-24mesi Allergologo 60% 70 – 60 – 50 – 40 – 30 – 20 – 10 –0 17% 15% 8% RISULTATI – Terapia 2 Järvinen KM, JACI in Pract; 2013; 1:317-22

19 Clinica Pediatrica Università di Verona CONCLUSIONE È necessaria una maggiore informazione riguardo all’FPIES, in merito alle diverse forme cliniche ed alla gestione terapeutica acuta ed a lungo termine.


Scaricare ppt "Conoscenza della Food Protein-Induced Enterocolitis Syndrome (FPIES) tra i pediatri di famiglia Pasquale Comberiati Clinica Pediatrica Università di Verona."

Presentazioni simili


Annunci Google