Food protein-induced enterocolitis syndrome : Current Opinion in Allergy and Clinical Immunology

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Anaphylaxis and insect allergy: Edited by Theodore Freeman and Gideon Lack

Food protein-induced enterocolitis syndrome

Nowak-Węgrzyn, Anna; Muraro, Antonella

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Current Opinion in Allergy and Clinical Immunology 9(4):p 371-377, August 2009. | DOI: 10.1097/ACI.0b013e32832d6315


Purpose of review 

To review current knowledge and recent advances in food protein-induced enterocolitis syndrome (FPIES).

Recent findings 

Rice is the most common solid food causing FPIES. Rice FPIES is associated with more severe reactions than other foods. Infants presenting acutely may be hypothermic (<36°C) and have thrombocytosis. Finding of hypoalbuminemia and weight gain less than 10 g/day helps to differentiate chronic infantile cow's milk FPIES from infectious causes. Gastric juice leukocytes more than 10 cells per high-power field are found in infants with positive oral food challenge to cow's milk.


FPIES is a non-IgE-mediated gastrointestinal food hypersensitivity disorder. Food protein-activated intestinal lymphocytes elaborate inflammatory cytokines that result in increased intestinal permeability, malabsorption, dysmotility, emesis, diarrhea, pain, and failure to thrive. Decreased intestinal transforming growth factor beta and increased TNFα may be important in FPIES. Cow's milk and soy are the most common causes of FPIES, but cereal grains (rice, oat, and barley), fish, poultry, and vegetables may also cause FPIES. The majority of FPIES resolve by age of 3 years.

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.

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