Food Protein-Induced Enterocolitis Syndrome

From Practice to Theory

Stefano Miceli Sopo; Monica Greco; Serena Monaco; Salvatore Tripodi; Mauro Calvani


Expert Rev Clin Immunol. 2013;9(8):707-715. 

In This Article

Most Frequent Culprit Foods

Bridget suffers from CM FPIES, Ernst and Katie from fish FPIES, Victor from rice FPIES. These four stories present us with the three most frequent culprit foods of FPIES. The predominant food is CM, with the exception of Australia, where rice is the most frequent. The latter is also the most commmon solid culprit food worldwide, unless in Italy where fish is the most relevant one. In the United States some studies were published reporting a double reactivity to CM and soy in 50% of patients and this fact has led the suggestion for preventive dietary therapies[17] (we will discuss about this aspect next in the article). On the contrary, in Israel none out of 44 children affected by CM FPIES had any problem with soy.[4] In summary, there are some FPIES geographical differences, so that clinical approaches cannot be always the same. Some prudent dietetic attitudes that can be suitable in a particular geographical area could be wrong elsewere. In addition to rice and fish, among some solid culprit foods identified were oat, barley, poultry, turkey, egg, peas, peanut, potatoes, fruits and shellfish. Recently, we also detected an episode of FPIES caused by corn,[18] so this food can be added to the list.

In our study,[5] CM was the culprit food in 67% of cases. Fish was involved in 12% of cases. Approximately three out of eight children suffering from fish FPIES also performed an OFC with types of fish different from the culprit one (the remaining children did not agree with this proposal) with the following results:

  • A child affected by sole FPIES tolerated codfish and tuna;

  • A child affected by codfish and sole FPIES tolerated salmon and swordfish;

  • A child affected by trout and sole FPIES tolerated seabream, codfish and perch.

In summary, as happens in IgE-mediated fish allergy,[19] it is possible that even in fish FPIES the patient is able to tolerate other types of fish and this fact is very important as, together with the baked food mentioned before, it can help improve patients' quality of life by expanding their food choices and making their diet less limited. So, it's now the time to discuss one of the most important management aspect of FPIES, the diet therapy.