At Last…FPIES Register
We hope you would not miss the chance to suspect an FPIES diagnosis when you meet a patient suffering from it. To do this, the only things you need to know are the main FPIES diagnostic criteria, as for example the first four ones we discussed before (see Table 2); an allergist will take care of all the other specialist aspects of this syndrome such as the consequent diagnostic work-up, the definitive diagnosis and the correct dietary management. As often happens in medicine, there is still a gray zone in FPIES, including different methods of performing OFCs. Some authors, ourselves included, disagree a little with published methods: oral challenge involves the administration of food protein, 0.15–0.3 g protein/kg body weight, up to a maximum of 10 g, in three doses over 30−45 min. For example, we do not understand why the established dose should be administered three times in 30−45 min if vomiting usually occurs 2 h after the beginning of ingestion. However, this is a very specialist aspect, which should interest only allergists, those few who are used to performing OFC in their daily clinical practice. Anyway, you will find some hints about this problem in our case review. All the things we ignore about FPIES are inversely proportional to all we learnt about this syndrome. After all, the number of cases published at the end of 2012 do not exceed 400 units and this is not only due to the fact that FPIES is an uncommon disease (Katz et al. registered CM-FPIES in 0.5% of newborns), but because it is not well-known and studied. To remedy this situation, we are going to set up the Italian FPIES Register. Our aim is to collect a significant number of cases to throw light on new aspects of this syndrome; thanks to information gathered, a FPIES guideline could be outlined to follow in clinical practice. That's the meaning of 'from practice to theory'.
Expert Rev Clin Immunol. 2013;9(8):707-715. © 2013 Expert Reviews Ltd.