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Food-Protein-Induced Enterocolitis Syndrome: A Pediatric Gastrointestinal Food Allergy

  • Amanda Agyemang
  • Anna Nowak-WegrzynEmail author
Chapter
  • 56 Downloads

Abstract

FPIES is a rare, non-IgE-mediated food allergy that is characterized by gastrointestinal symptoms that are triggered by specific food allergens. Acute FPIES is identified by delayed repetitive vomiting, pallor, and lethargy within 1–4 hours after an isolated ingestion of a food trigger and possible diarrhea within 24 hours of ingestion. Chronic FPIES is the result of more regular (e.g., daily) ingestion of the trigger foods and leads to intermittent vomiting, chronic watery diarrhea, and failure to thrive. In the United States, cow’s milk and soy most commonly cause FPIES symptoms in infants and upon solid food introduction, grains such as rice and oat become the most common culprit foods. Diagnosis relies on the recognition of the symptom pattern but can be confirmed by the gold standard of diagnosis: oral food challenge. Introducing new foods and reintroducing a trigger food are two of the most challenging aspects of managing FPIES as it often requires a multidisciplinary approach with equal participation from the family, the clinician, and nutritionist. The first international guidelines on diagnosis and management of FPIES, published in 2017, are an important comprehensive resource for clinicians to use to identify patients at risk, treat acute symptoms, reduce exposures to trigger foods and overall improve patients’ nutritional intake and quality of life.

Keywords

FPIES Food-protein-induced enterocolitis syndrome Food allergy Cow milk Soy Oral food challenge Non-IgE-mediated food allergy 

Abbreviations

APT

Atopy patch testing

CM

Cow’s milk

FPIES

Food-protein-induced enterocolitis syndrome

IQR

Interquartile range

IV

Intravenous

OFC

Oral food challenge

ssIgE

Serum-specific IgE

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Kravis Children’s Hospital, Icahn School of MedicineNew YorkUSA
  2. 2.Allergy and Immunology, Department of Pediatrics, NYU Langone HealthNew YorkUSA
  3. 3.Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and MazuryOlsztynPoland

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