Second Criterion: 'Exposure to the Incriminated Food Elicited Repetitive Vomiting and/or Diarrhea Within 4 h Without Any Other Cause for the Symptoms'
In 2012 Leonard et al. suggested that food ingestion has to be repetitive and that the elicited symptoms are generic gastrointestinal, not specifically vomiting and/or diarrhea. However, we do not agree with these changes. In fact, as it is stated in the fifth criterion (see below), at least two episodes are necessary to make the definitive diagnosis. Moreover, FPIES has to be suspected (not diagnosed) even if only a one episode occurred, so the need for repetitive ingestion specified by Leonard et al. could divert doctors' attention from a possible diagnosis of the syndrome. We would rather focus on symptom duration, which is usually short in time. In fact, patients take 6−8 h to recover and at the end of all, they appear as if nothing wrong has happened. This last one is a unique characteristic of FPIES, and it can not be found in other diseases, not IgE-mediated which could gloss over this syndrome as acute gastroenteritis but also surgical abdomen and sepsis. We would also highlight that vomiting is undoubtely the prevalent symptom accompanied by hyporeactivity and pallor, as opposed to diarrhea, which is a secondary and inconstant aspect of the syndrome. It would be inaccurate to make a FPIES diagnosis if the patient presents with diarrhea without vomiting, although the conjunctions 'and/or' do not seem to underline the difference.
Expert Rev Clin Immunol. 2013;9(8):707-715. © 2013 Expert Reviews Ltd.