PMID- 34408963
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210820
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 8
DP  - 2021 Aug
TI  - Wheat Protein-Induced Enterocolitis Syndrome Complicated With Wheezing: An 
      Approach to Diagnosis and Wheat Reintroduction.
PG  - e17141
LID - 10.7759/cureus.17141 [doi]
LID - e17141
AB  - An 11-month-old Japanese girl was diagnosed with food protein-induced 
      enterocolitis syndrome (FPIES) after presenting with vomiting approximately two 
      hours after wheat intake. She showed positive results on the first wheat oral 
      food challenge (OFC) at nine months of age, although serum wheat- and omega-5 
      gliadin-specific immunoglobulin E (IgE) were not detected. The second wheat OFC, 
      performed at age 13 months, induced wheezing (usually an IgE-mediated symptom) 
      4.5 hours after ingestion, probably owing to gastroesophageal reflux caused by 
      repetitive vomiting. The third wheat OFC, performed at age 25 months, did not 
      trigger reactions. Therefore, gradual low-dose wheat was reintroduced at home. 
      The fourth wheat OFC performed at age 30 months induced no response either; thus, 
      the patient was deemed to have developed tolerance to wheat. This case report, 
      therefore, demonstrates that careful assessment of natural history and 
      physician-supervised OFCs are necessary for adequate diagnosis and the successful 
      management of reintroduction in wheat-induced FPIES.
CI  - Copyright (c) 2021, Shinohara et al.
FAU - Shinohara, Miwa S
AU  - Shinohara MS
AD  - Medical Sciences in Clinical Investigation, Harvard Medical School, Boston, USA.
AD  - Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, JPN.
AD  - Department of Pediatrics, Ehime University Hospital, Toon, JPN.
FAU - Nino, Ryuji
AU  - Nino R
AD  - Department of Pediatrics, Ehime Prefectural Imabari Hospital, Imabari, JPN.
FAU - Higaki, Takashi
AU  - Higaki T
AD  - Department of Pediatrics, Ehime University Faculty of Medicine, Toon, JPN.
AD  - Center for Transition to Adult Congenital Heart Disease, Ehime University 
      Hospital, Toon, JPN.
FAU - Ishii, Eiichi
AU  - Ishii E
AD  - Department of Pediatrics, Ehime University Faculty of Medicine, Toon, JPN.
AD  - Department of Pediatrics, Imabari City Medical Association Municipal Hospital, 
      Imabari, JPN.
LA  - eng
PT  - Case Reports
DEP - 20210813
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8361370
OTO - NOTNLM
OT  - oral food challenge
OT  - protein-induced enterocolitis syndrome
OT  - reintroduction
OT  - wheat
OT  - wheezing
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/08/20 06:00
MHDA- 2021/08/20 06:01
PMCR- 2021/08/13
CRDT- 2021/08/19 06:43
PHST- 2021/08/12 00:00 [accepted]
PHST- 2021/08/19 06:43 [entrez]
PHST- 2021/08/20 06:00 [pubmed]
PHST- 2021/08/20 06:01 [medline]
PHST- 2021/08/13 00:00 [pmc-release]
AID - 10.7759/cureus.17141 [doi]
PST - epublish
SO  - Cureus. 2021 Aug 13;13(8):e17141. doi: 10.7759/cureus.17141. eCollection 2021 
      Aug.