Differential diagnosis of food protein-induced enterocolitis syndrome

Abstract

Purpose of reviewTo assess all the possible differential diagnosis of food protein-induced enterocolitis syndrome (FPIES), both in acute and chronic presentation, reviewing the data reported in published studies.Recent findingsThere is an increase of reported cases of FPIES in recent years. As the disease presents with nonspecific symptoms, it can be misunderstood in many ways. The differential diagnosis includes, in acute presentations, the following: sepsis, other infectious diseases, acute gastrointestinal episodes, surgical emergencies, food allergies. In its chronic forms, FPIES may mimic malabsorption syndromes, metabolic disorders, primary immunodeficiencies, neurological conditions, coagulation defects, and other types of non-IgE-mediated food allergy.SummaryA thorough clinical evaluation, including symptoms, signs, and laboratory findings, is necessary to lead the clinicians toward the diagnosis of FPIES. The major reason for delayed diagnosis appears to be the lack of knowledge of the disease.

Allergic gastroenteritis hospital admission time trends in Australia and New Zealand

“…The observation that rates of admission for AG in both countries for the <1 year age group were very similar is supportive of the possibility that the majority of these cases represent FPIES. If the increase in AG is confirmed by other studies, and not an solely an artefact of improved recognition of disorders such as FPIES and coding, it will be of interest to determine if factors thought to contribute to the increase in IgE‐mediated FA might also play a role in non‐IgE‐mediated gastroenterological FA syndromes.…”

Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy

“…For infants presenting with vomiting and lethargy, these studies may help in narrowing the broad differential diagnosis, which includes sepsis, infectious gastroenteritis, necrotizing enterocolitis, bowel obstruction, inborn errors of metabolism, celiac disease, inflammatory bowel disease, eosinophilic gastrointestinal disease, and anaphylaxis [37]. Laboratory findings consistent with acute or ongoing FPIES reaction include leukocytosis with neutrophilia, thrombocytosis, non-anion gap acidosis, methemoglobinemia, and hypoalbuminemia [3,13,22].…”

Chronic food protein–induced enterocolitis syndrome

“…Because FPIES lacks specific biomarkers, the differential diagnosis is extensive (Table 3). 35 In its chronic form, FPIES resembles metabolic disorders, primary immunodeficiencies, neurologic conditions, and other types of noneIgE-mediated food allergy, such as food proteineinduced enteropathy, allergic proctocolitis, eosinophilic esophagitis, eosinophilic gastroenteritis, or other nonspecific noneIgE-mediated gastrointestinal food allergies. 35e37 In its acute presentation, FPIES can present similarly to sepsis, acute gastroenteritis, anaphylaxis, and surgical emergencies.…”