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Review
. 2023 Sep 1;44(5):368-373.
doi: 10.2500/aap.2023.44.230047.

Pearls and pitfalls in food protein-induced enterocolitis syndrome (FPIES)

Stella Hartono  1 , Elena Zidan  2 , Prasiksha Sitaula  3 , Joel P Brooks  3
Affiliations
Review

Pearls and pitfalls in food protein-induced enterocolitis syndrome (FPIES)

Stella Hartono et al. Allergy Asthma Proc. .

Abstract

Background: Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-immunoglobulin E (IgE) mediated gastrointestinal food hypersensitivity. It is a clinical diagnosis commonly characterized by profuse vomiting 1 to 4 hours after ingestion of the triggering food(s). Objective: The objective was to increase awareness of FPIES and review the epidemiology, clinical presentation, pathogenesis, diagnosis, and management of FPIES. The lack of availability of a definite biomarker or diagnostic tool often leads to a delay in diagnosis. Methods: A literature search of salient articles that described case reports and case series of FPIES and their management were analyzed. Results: A case of FPIES with a literature review is presented with emphasis on clinical pearls and pitfalls. FPIES is a diagnosis of exclusion and the mainstay of treatment is avoidance of the trigger food(s) for at least 12-18 months from the last exposure. Conclusion: As FPIES is a non-IgE-mediated reaction, allergy testing via skin-prick test or blood tests to measure food IgE antibodies is not routinely recommended. Many children outgrow FPIES by 3-4 years of age. Supervised oral food challenge is recommended to assess acquisition of tolerance.

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Figures

Figure 1.
Figure 1.
The pathophysiology of FPIES.
See this image and copyright information in PMC

References

    1. Gonzalez-Delgado P, Muriel J, Jimenez T, et al. . Food protein-induced enterocolitis syndrome in adulthood: clinical characteristics, rognosis, and risk factors. J Allergy Clin Immunol Pract. 2022; 10:2397–2403. - PubMed
    1. Katz Y, Goldberg MR, Rajuan N, et al. . The prevalence and natural course of food protein-induced enterocolitis syndrome to cow's milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011; 127:647–653.e1-e3. - PubMed
    1. Mehr S, Frith K, Barnes EH, et al. . Food protein-induced enterocolitis syndrome in Australia: a population-based study, 2012-2014. J Allergy Clin Immunol. 2017; 140:1323–1330. - PubMed
    1. Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. . International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017; 139:1111–1126.e4. - PubMed
    1. Michelet M, Schluckebier D, Petit L-M, et al. . Food protein-induced enterocolitis syndrome - a review of the literature with focus on clinical management. J Asthma Allergy. 2017; 10:197–207. - PMC - PubMed

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