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Food Protein-Induced Enterocolitis Syndrome (FPIES): Review of Recent Guidelines

  • Food Allergy (T Green, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To increase understanding of food protein-induced enterocolitis syndrome (FPIES), a non-immunoglobulin E (IgE)-mediated reaction to food, by reviewing a growing body of literature, including recently published international consensus guidelines.

Recent Findings

FPIES primarily affects infants and young children and is characterized by the delayed onset of gastrointestinal symptoms, predominantly repetitive vomiting, in response to a trigger food. Symptoms are often severe and can lead to shock. Diagnosis can be challenging due to a wide differential diagnoses and lack of disease biomarkers. FPIES is a clinical diagnosis, with allergy testing playing a very limited role, if any. Medically supervised oral food challenges are used to monitor resolution of disease, which generally occurs in early childhood.

Summary

FPIES is an important condition presenting to clinicians in a variety of settings. Recent international consensus guidelines and a growing body of literature can better equip practitioners to care for these often-challenging patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Katz Y, Goldberg MR. Natural history of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):229–39. https://doi.org/10.1097/ACI.0000000000000053.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. • Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134(2):382–389.e4. https://doi.org/10.1016/j.jaci.2014.04.008. Description of clinical presentation and natural history of FPIES.

    Article  PubMed  Google Scholar 

  3. •• Nowak-Węgrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, 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(4):1111–1126.e4. https://doi.org/10.1016/j.jaci.2016.12.966. Guidelines addressing the most recent recommendations for the diagnosis and management of FPIES, including diagnostic criteria.

    Article  PubMed  Google Scholar 

  4. Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111(4):829–35. https://doi.org/10.1542/peds.111.4.829.

    Article  PubMed  Google Scholar 

  5. Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. 2005;115(1):149–56. https://doi.org/10.1016/j.jaci.2004.09.033.

    Article  PubMed  Google Scholar 

  6. Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123(3):e459–64. https://doi.org/10.1542/peds.2008-2029.

    Article  PubMed  Google Scholar 

  7. Sopo SM, Giorgio V, Iacono ID, Novembre E, Mori F, Onesimo R. A multicentre retrospective study of 66 Italian children with food protein-induced enterocolitis syndrome: different management for different phenotypes. Clin Exp Allergy. 2012;42(8):1257–65. https://doi.org/10.1111/j.1365-2222.2012.04027.x.

    Article  PubMed  Google Scholar 

  8. Leonard SA, Chehade M. Food protein-induced enterocolitis syndrome. J Allergy Clin Immunol Pract. 2017;5(2):525–6. https://doi.org/10.1016/j.jaip.2016.10.022.

    Article  PubMed  Google Scholar 

  9. Feuille E, Nowak-Węgrzyn A. Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14(3):222–8. https://doi.org/10.1097/ACI.0000000000000055.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Järvinen KM, Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome (FPIES): current management strategies and review of the literature. J Allergy Clin Immunol Pract. 2013;1(4):317–322.e4. https://doi.org/10.1016/j.jaip.2013.04.004.

    Article  PubMed  Google Scholar 

  11. Li H, Nowak–Wegrzyn A, Charlop–Powers Z, Shreffler W, Chehade M, Thomas S, et al. Transcytosis of IgE–antigen complexes by CD23a in human intestinal epithelial cells and its role in food allergy. Gastroenterology. 2006;131(1):47–58. https://doi.org/10.1053/j.gastro.2006.03.044.

    Article  CAS  PubMed  Google Scholar 

  12. Mori F, Barni S, Cianferoni A, Pucci N, de Martino M, Novembre E. Cytokine expression in CD3+ cells in an infant with food protein-induced enterocolitis syndrome (FPIES): case report. Clin Dev Immunol. 2009;2009:1–4. https://doi.org/10.1155/2009/679381.

    Article  Google Scholar 

  13. Morita H, Nomura I, Orihara K, Yoshida K, Akasawa A, Tachimoto H, et al. T-cell responses in patients with non-IgE-mediated gastrointestinal food allergy are predominantly skewed to T(H)2. J Allergy Clin Immunol. 2013;131(2):590–592.e6. https://doi.org/10.1016/j.jaci.2012.09.005.

    Article  CAS  PubMed  Google Scholar 

  14. Shek LPC, Bardina L, Castro R, Sampson HA, Beyer K. Humoral and cellular responses to cow milk proteins in patients with milk-induced IgE-mediated and non-IgE-mediated disorders. Allergy. 2005;60(7):912–9. https://doi.org/10.1111/j.1398-9995.2005.00705.x.

    Article  CAS  PubMed  Google Scholar 

  15. Miceli Sopo S, Battista A, Greco M, Monaco S. Ondansetron for food protein-induced enterocolitis syndrome. Int Arch Allergy Immunol. 2014;164(2):137–9. https://doi.org/10.1159/000363384.

    Article  CAS  PubMed  Google Scholar 

  16. • Miceli Sopo S, Bersani G, Monaco S, Cerchiara G, Lee E, Campbell D, et al. Ondansetron in acute food protein-induced enterocolitis syndrome, a retrospective case–control study. Allergy. 2017;72(4):545–51. https://doi.org/10.1111/all.13033. Study highlighting successful use of ondansetron in acute FPIES reactions indicative of a new role for the medication in FPIES management.

    Article  CAS  PubMed  Google Scholar 

  17. Greenhawt M, Bird JA, Nowak-Węgrzyn AH. Trends in provider management of patients with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol Pract. 2017;5(5):1319–1324.e12. https://doi.org/10.1016/j.jaip.2016.11.036.

    Article  PubMed  Google Scholar 

  18. Järvinen KM, Caubet J, Sickles L, Ford LS, Sampson HA, Nowak-Węgrzyn A. Poor utility of atopy patch test in predicting tolerance development in food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol. 2012;109(3):221–2. https://doi.org/10.1016/j.anai.2012.06.020.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fiocchi A, Claps A, Dahdah L, Brindisi G, Dionisi-Vici C, Martelli A. Differential diagnosis of food protein-induced enterocolitis syndrome. Curr Opinion Allergy Clin Immunol. 2014;14(3):246–54. https://doi.org/10.1097/ACI.0000000000000057.

    Article  CAS  Google Scholar 

  20. Holbrook T, Keet CA, Frischmeyer-Guerrerio PA, Wood RA. Use of ondansetron for food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2013;132(5):1219–20. https://doi.org/10.1016/j.jaci.2013.06.021.

    Article  PubMed  Google Scholar 

  21. • Groetch M, Henry M, Feuling MB, Kim J. Guidance for the nutrition management of gastrointestinal allergy in pediatrics. J Allergy Clin Immunol in Practice. 2013;1(4):323–31. https://doi.org/10.1016/j.jaip.2013.05.002. Guidelines for nutritional management of patients with FPIES and other gastrointestinal allergy and the role of dieticians in management.

    Article  Google Scholar 

  22. Coulthard H, Harris G, Emmett P. Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age. Matern Child Nutr. 2009;5(1):75–85. https://doi.org/10.1111/j.1740-8709.2008.00153.x.

    Article  PubMed  Google Scholar 

  23. Boyce J, NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. J Allergy Clin Immunol. 2010;126(6):1105–18. https://doi.org/10.1016/j.jaci.2010.10.008.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hwang J, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. 2008, 2009;94(6):425–8. https://doi.org/10.1136/adc.2008.143289.

    Article  PubMed  Google Scholar 

  25. •• Nowak-Wegrzyn, A., & Adverse Reactions to Food Committee of American Academy of Allergy, Asthma & Immunology. Work group report: oral food challenge testing. J Allergy Clin Immunol. 2009; 123(6 Suppl), S365–S383. https://doi.org/10.1016/j.jaci.2009.03.042. Guidelines for oral food challenge to assess resolution of FPIES.

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Authors and Affiliations

  1. Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, TX, USA

    Sheeba Cherian & Pooja Varshney

  2. Dell Children’s Medical Center of Central Texas/Dell Children’s Medical Group, 1301 Barbara Jordan Blvd, Suite 200, Austin, TX, 78723, USA

    Pooja Varshney

Authors
  1. Sheeba Cherian
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  2. Pooja Varshney
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Correspondence to Pooja Varshney.

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The authors declare no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Food Allergy

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Cherian, S., Varshney, P. Food Protein-Induced Enterocolitis Syndrome (FPIES): Review of Recent Guidelines. Curr Allergy Asthma Rep 18, 28 (2018). https://doi.org/10.1007/s11882-018-0767-9

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  • DOI: https://doi.org/10.1007/s11882-018-0767-9

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