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

From Practice to Theory

Bridget was lucky, since the story of her first clinical reaction was heard by a young resident pediatrician who knew FPIES and was able to plan a correct work-up to understand the baby's problem. Thanks to that, the second reaction was induced in a safest place which was well equipped and ready to face any harmful situation. Ernst instead wasn't as lucky as Bridget, because nobody considered either the hypothesis of FPIES or even a generic food allergy (FA). The child had three episodes at home without any appropriate assistance, in danger of a more severe outcome. These two stories are suitable for learning a lot about FPIES, as they exemplify some well-known and even uncommon aspects of this syndrome:

  • FPIES pathogenesis is probably non-IgE-mediated, so culpritfood-specific IgE research is almost always negative;

  • The period of life during which FPIES appears most frequently is the first 9 months after birth;

  • The most frequent culprit food (except in Australia) is CM;

  • The most frequent solid food that induces FPIES in Italy is fish, while worldwide it is rice;

  • FPIES symptoms are vomiting, hyporeactivity, hypotonia and sometimes diarrhea;

  • The evolution of FPIES is benign in a few hours;

  • Diagnostic criteria consist of the occurrence of at least two typical episodes;

  • There is often a diagnostic delay – as many as six episodes could take place before the situation is clarified;

  • Acute therapeutical measures are iv. fluids and cortisone;

  • Dietetic measures consist of eliminating the culprit food from the patient's diet;

  • As far as prognosis is concerned, there is a good chance of achieving tolerance at 18 months if the responsible food is CM; however, there aren't enough data for other foods.