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Diagnosis and Management of Chronic FPIES

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Food Protein Induced Enterocolitis (FPIES)

Abstract

Chronic FPIES typically occurs in infants when the food trigger, cow’s milk- or soy-based formula, is ingested on a regular basis. Symptoms may initially include watery diarrhea, intermittent vomiting, and irritability but will progress to include failure to thrive, lethargy, and dehydration or even shock if unrecognized. Due to the nonspecific nature of these symptoms, the diagnosis of chronic FPIES can be missed early on in the course, and the diagnosis is definitively confirmed only through provocation of an acute FPIES reaction upon a supervised oral food challenge with the culprit food, following a period of days to weeks of food avoidance. The cornerstone of management is strict avoidance of cow’s milk- and soy-based formulas. Breastfeeding, extensively hydrolyzed cow’s milk formula, and elemental formula are preferred sources of nutrition. Due to the increased risk of acute FPIES to solid foods among infants with chronic FPIES, it is generally recommended that solid foods be introduced starting at age 6 months with a gradual progression from lower- to higher-risk foods. Consultation with a nutritionist can help ensure adequate nutrition and promote normal growth and development during the avoidance period. The time to FPIES resolution varies, but the prognosis is favorable with most children developing tolerance by school age.

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Author information

Authors and Affiliations

  1. Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mary Grace Baker

  2. Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anna Nowak-Wegrzyn

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  1. Mary Grace Baker
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  2. Anna Nowak-Wegrzyn
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Correspondence to Anna Nowak-Wegrzyn .

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Editors and Affiliations

  1. Division of Allergy and Immunology, University of Pennsylvania, Perelman School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Terri Faye Brown-Whitehorn

  2. Division of Allergy and Immunology, University of Pennsylvania, Perelman School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Antonella Cianferoni

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Baker, M.G., Nowak-Wegrzyn, A. (2019). Diagnosis and Management of Chronic FPIES. In: Brown-Whitehorn, T., Cianferoni, A. (eds) Food Protein Induced Enterocolitis (FPIES). Springer, Cham. https://doi.org/10.1007/978-3-030-21229-2_6

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  • DOI: https://doi.org/10.1007/978-3-030-21229-2_6

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  • Online ISBN: 978-3-030-21229-2

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