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Food protein-induced enterocolitis syndrome

Nowak-Węgrzyn, Anna; Muraro, Antonella

Current Opinion in Allergy and Clinical Immunology: August 2009 - Volume 9 - Issue 4 - p 371–377
doi: 10.1097/ACI.0b013e32832d6315
Anaphylaxis and insect allergy: Edited by Theodore Freeman and Gideon Lack

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.

Summary 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.

aJaffe Food Allergy Institute, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA

bReferral Centre for Food Allergy Diagnosis and Treatment Department of Pediatrics, University of Padua, Padua, Italy

Correspondence to Anna Nowak-Węgrzyn, MD, Assistant Professor of Pediatrics, Mount Sinai School of Medicine, Department of Pediatrics, Division of Allergy and Immunology, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA Tel: +1 212 241 9489; fax: +1 212 426 1902; e-mail:

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