Third Criterion: 'Symptoms Limited to the GI Tract'
It is difficult to believe that hypotonia, hyporeactivity and pallor are related to a GI problem. These symptoms could be rather caused by hypotension, which may be a consequence of fluid loss with vomiting. We think that they are most probably triggered by a toxemia deriving from a cytochine blood invasion, related to an allergic inflammation state. So we do not agree with the third Powell criterion; we prefer Leonard et al.'s criterion, which requires the absence of symptoms compatible with an IgE-mediated reaction. For example, repetitive vomiting and hyporeactivity presenting 2 h after the ingestion of food, accompanied by hives, should mistrust a FPIES diagnosis, because hives as well as asthma and rhinitis are typical manifestations of an IgE-mediated allergy. However, we will discuss hereinafter the FPIES pathogenesis, which is an interesting and innovative aspect of this syndrome.
Expert Rev Clin Immunol. 2013;9(8):707-715. © 2013 Expert Reviews Ltd.