Latest Insights on Food Protein–Induced Enterocolitis Syndrome: An Emerging Medical Condition

Abstract

Food protein-induced enterocolitis syndrome (FPIES) is a type of non-IgE-mediated gastrointestinal food hypersensitivity characterized by profuse vomiting that is frequently associated with pallor or/and lethargy and appears within 1 to 3 hours after ingestion of the offending food. A less frequent chronic form of FPIES is characterized by protracted vomiting, diarrhea, or both accompanied by poor growth. Although FPIES is considered a rare allergic disorder, increasing reports in recent years point to a real increase in incidence, or at least an increased awareness of this condition by pediatricians. The foods most frequently implicated are cow's milk, soy formula, grains, and fish, depending on the geographic area. Diagnosis is based on clinical manifestations and requires a high index of suspicion, since we still lack a diagnostic laboratory tool. Early recognition of FPIES and removal of the offending food are mandatory. International consensus guidelines on diagnosis and management have been published. Prognosis is usually good, with most children tolerating foods before 6 years of age.

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

“…It is worth discussing separately our results related to FPIES, due to its unique characteristics. Although FPIES is defined as a rare disease, 26,27 in our study population, 7.7% of children were affected by FPIES. Although literature suggested that FPIES is prevalent in males, 28 our cohort was almost equally composed by males (51.9%) and females (48.1%).…”

Oral Food Challenge in Food Protein-Induced Enterocolitis Syndrome by Fish: Is There Any Room for Improvement?

“…If no acute symptoms occurred, patients were discharged home after 4 h of observation. Finally, in 2017, Vazquez-Ortiz et al [7] administered 0.3 g/kg of the food protein (3 g as maximal dose) divided into 3 equal doses given at 90-min intervals if no reaction occurred and, in 2018, Vila Sexto [4] administered the full serving size per age divided into 5 equal doses given every 20 min followed by 4 h of observation.…”

Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations

“…Typically, an OFC should be considered between 18 and 24 months from the last FPIES episode to determine tolerance. 6 Most children will have resolution of their FPIES between the ages of 3 and 5 years. The age that tolerance develops to an offending food item depends on the food item in question, population, and severity of initial reaction.…”