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Clinical manifestations of food protein-induced enterocolitis syndrome

Mane, Shikha K.; Bahna, Sami L.

Current Opinion in Allergy & Clinical Immunology: June 2014 - Volume 14 - Issue 3 - p 217–221
doi: 10.1097/ACI.0000000000000052
FOOD ALLERGY: Edited by Alessandro Fiocchi and Julie Wang

Purpose of review: To raise awareness among healthcare providers about the clinical and laboratory findings in acute and chronic food protein-induced enterocolitis syndrome (FPIES).

Recent findings: FPIES can be caused by trivial exposure or rare foods.

Summary: FPIES is a non-IgE-mediated reaction that usually presents with acute severe repetitive vomiting and diarrhea associated with lethargy, pallor, dehydration, and even hypovolemic shock. Manifestations resolve usually within 24–48 h of elimination of the causative food. In chronic cases, symptoms may include persistent diarrhea, poor weight gain, failure to thrive, and improvement may take several days after the food elimination. In the acute cases, laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking about 6 h postingestion. Depending on the severity, metabolic acidosis and methemoglobinemia may occur. In chronic cases, anemia, hypoalbuminemia and eosinophilia may be seen. Radiologic evaluation or other procedures, such as endoscopy and gastric juice analysis may show nonspecific abnormal findings. The diagnosis is based on clinical manifestations. Further studies looking at the phenotypes of FPIES are needed to identify clinical subtypes, and to understand the predisposing factors for developing FPIES compared with immediate-type, IgE-mediated gastroenteropathies.

Section of Allergy and Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA

Correspondence to Sami L. Bahna, MD, DrPH, Allergy and Immunology Section, Department of Pediatrics, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA. Tel: +1 318 675 7625; e-mail:

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