Katie's Story: She Was Misunderstood
On many occasions the baby vomited repetitively within 2 h of fish ingestion, especially sole fish. SPTs performed with sole commercial extract and fresh sole (both cooked and raw) were negative. Katie was admitted to the DH to perform an OFC with cooked sole; she ingested about 30 g of fish but refused to continue. Two and a half hours after the ingestion, Katie started to vomit and presented with pallor and sweating. We did not think of FPIES; we thought it was a sort of psychological aversion toward fish, so we suggested to give her sole fish at home, but in a hidden form. Fortunately Katie's parents didn't follow that advice.
The story of Katie allows us to emphasize that the diagnosis of FPIES can be made if this syndrome is known, otherwise not. This is the case for all other diseases. Anyway, even though pediatricians do not easily suspect FPIES, often causing a diagnostic delay, the number of diagnoses is notably increasing. Australians were the first to become aware of FPIES, but now we are too: in 2008 our diagnoses tripled, compared to the annual mean of the previous four-year period, and in the following years, the number of new diagnoses remained stable. This phenomenon can be considered a sort of paradox, that is: on one hand doctors do not seem to consider FPIES a lot, on the other hand it seems they think of it too much. Such a strange contradiction could be explained, at least in Italy, considering that knowledge of FPIES in the pediatric allergic field has spread in few years, thanks to congresses, scientific journals and discussion forums. Primary-care pediatricians, who are the ones in direct touch with children and their parents, have been receiving this information more recently. There is still too much to do, as shown in the next story, which exemplifies other interesting aspects of FPIES.
Expert Rev Clin Immunol. 2013;9(8):707-715. © 2013 Expert Reviews Ltd.