Food protein‐induced enterocolitis syndrome

Abstract

Food protein‐induced enterocolitis syndrome (FPIES) is a non‐IgE‐mediated gastrointestinal food allergic disorder that has gained a major interest the past decade. FPIES prevalence, which still needs to be accurately determine in different populations, appears to be higher than previously thought (ie up to 0.7% in infants in the 1st year of life). FPIES to seafood in adults is also increasingly reported; limited data suggest that adult FPIES is most commonly triggered by shellfish, tends to affect females more than men, is characterized by a significant delay in diagnosis and a prolonged course. The first international consensus guidelines on diagnosis and management of FPIES have been published in 2017, proposing new diagnostic criteria as well as new criteria for a positive oral food challenge. However, there is a need to develop new biomarkers to improve the diagnosis and management of FPIES patients, and this requires a better understanding of the pathophysiology. Recently, the role of T cells has been questioned and a major role of innate immune cells has been suggested in acute FPIES. Regarding the treatment of acute FPIES reaction, ondansetron has emerged as an adjunct to intravenous rehydration in moderate‐severe reactions and as a first‐line treatment in mild reactions. Important information regarding the nutritional management of FPIES patients that might be complex has also been provided in the international guidelines. In this review, we discuss recent advances regarding all those different aspects.

Shock in a Newborn: A Rare Cause

“…In Spain, FPIES was reported to affect 0.7% of infants younger than 12 months in a single-center population-based birth cohort. 1,4,5…”

Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update

“…These are likely influenced by local dietary practices and may be the result of differences in genetic background [102]. As a whole, common triggers reflect those foods introduced during the first year of life, as index reactions are unlikely to occur in foods introduced thereafter [26,61,93]. While the majority (65-80%) of children react to a single food, most commonly cow's milk, about 10% of children will react to three foods or more.…”

“…FPIES generally resolves before 3 to 5 years of age, but this may vary by type of food (i.e., solid vs. liquid) and geographical location [61]. An older age at diagnosis and atypical FPIES are associated with a prolonged course [26,75].…”

“…Diarrhea can also follow 5 to 10 h later, although this is a less common feature (25–50%). Infants often appear septic, presenting with symptoms of lethargy (65–100%), pallor (30–90%) and hypothermia (5%) [ 24 , 26 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. Symptoms may be quite severe, with up to 15% experiencing hemodynamic instability [ 65 , 68 ].…”

Necrotizing Enterocolitis: The Future

“…Primarily recognized as a problem seen outside of the neonatal period during infancy, food protein-induced enterocolitis syndrome (FPIES) can also occur in the neonatal period, presenting with abdominal distension, bloody stools and flank discoloration, which improve after being treated with hydrolyzed formula [26][27][28]. A cow's milk challenge and even breast feeding (if the mother is exposed to certain proteins) may result in relapse.…”