Expert Commentary & Five Year View
FPIES is an old FA that has been rediscovered in recent years. It is probably modified in its clinical expression. In past years chronic forms prevailed, managed mainly by gastroenterologists. Today, perhaps due to a more aggressive management of mild disorders of the GI tract (regurgitation, mild diarrhea, poor weight gain) with frequent elimination of CM protein from infants' diet, acute forms definitely prevail. Today, we know a lot of epidemiological information: the prevalence of this syndrome, the foods involved and the type of clinical expression. However, many aspects remain to be fully investigated: the immunological pathogenesis, diagnostic laboratory investigations, the methodology of OFCs, the prognosis and some aspects of diet therapy. For example, nothing is known about the possibility of performing OIT with the culprit food for those FPIES patients who remain allergic past the fourth or fifth year of life. On the contrary, this is a concrete chance for those children suffering from IgE-mediated FAs.
In addition to the Italian FPIES Register, we hope that the constitution of other national registers is in progress, as they will be useful to collect further information about FPIES. During the next five years, the method of performing OFCs should be improved to adapt them to the timing of FPIES symptoms. FPIES pathogenesis should be cleared, above all it would be significant to understand the specific IgE role, which could have great implications on acute episodes treatment. To improve patients' quality of life, it would be important to define multiple FPIES prevalence and identify some markers of this special phenotype, so that we could limit enlarged diets only to those patients who really need them. We will try to solve doubts about FPIES duration, especially for solid food FPIES, which is still less known, with the goal of giving a more precise prognosis to children and their families.
One thing is certain: in the last 30 years, our knowledge about FPIES has evolved and transformed. Who knows what lies ahead for the next few decades!
Expert Rev Clin Immunol. 2013;9(8):707-715. © 2013 Expert Reviews Ltd.