Clinical management of food protein-induced enterocolitis syndrome

Abstract

Purpose of reviewThe article discusses the clinical management of patients affected by food protein-induced enterocolitis syndrome (FPIES), focusing on established therapeutic choices and future options.Recent findingsAfter FPIES has been diagnosed and avoidance of the culprit food prescribed, the most important management needs are as follows. First, recurrence of acute FPIES episodes due to accidental ingestion of culprit food. It may be useful to give patients’ families an action plan. The principal suggested treatments are intravenous fluids and steroids, whereas the use of epinephrine and ondansetron requires further study. In mild-to-moderate cases, oral rehydration should be sufficient. Second, dietary introduction of at-risk foods. In children with FPIES, in addition to that/those identified as culprit(s), some foods may not be tolerated (typically cow's milk, legumes, cereals, poultry). It has been suggested to avoid introducing these foods during the baby's first year. Otherwise, they may be given for the first time in hospital, performing an oral food challenge. Third, acquisition of tolerance. Children affected by cow's milk-FPIES have a good chance of acquiring tolerance by the time they reach age 18–24 months. For other culprit foods, insufficient data are available to indicate the appropriate time, so that it is suggested that an oral food challenge be performed about 1 year after the last acute episode.SummaryFuture clinical management of FPIES must take into account, among other factors, improved understanding of pathogenesis, possible detection of different phenotypes, and the introduction of more effective therapies for acute episodes. These factors will undoubtedly influence management decisions, which will become more diversified and effective.

Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management

“…We recommend the introduction of one food per week. Introduction of any other animal milk, especially goat or sheep milk, is not recommended due to a higher risk of cross reactivity proteins 30,77…”

Ondansetron in acute food protein-induced enterocolitis syndrome, a retrospective case-control study

“…Oral food challenges (OFCs) may be necessary to confirm diagnosis in uncertain cases and in order to assess the disease resolution. The cornerstone of FPIES management is the avoidance of culprit food . Suggested therapy for moderate to severe acute episodes of FPIES consists in intravenous (iv) boluses of fluids and corticosteroids (‘traditional therapy’) .…”

Chronic food protein–induced enterocolitis syndrome

“…The long-term management of chronic FPIES is strict avoidance of the offending food. 1,51 It is difficult to assess the amount of protein that a patient can tolerate because of the late onset of the symptoms and the threshold dose may get smaller with repeated episodes. Formula is initially replaced with eHCF.…”