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

Authors Michelet M, Schluckebier D, Petit LM, Caubet JC

Received 9 November 2016

Accepted for publication 31 March 2017

Published 27 June 2017 Volume 2017:10 Pages 197—207

DOI https://doi.org/10.2147/JAA.S100379

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Luis Garcia-Marcos

Marine Michelet,1,* Dominique Schluckebier,2,* Laetitia-Marie Petit,2 Jean-Christoph Caubet3

1Children Hospital, Pediatric Allergology Unit CHU Toulouse, Toulouse, France; 2Geneva University Hospitals, Pediatric Gastroenterology Unit, 3Geneva University Hospitals, Pediatric Allergology Unit, Geneva, Switzerland

*These authors contributed equally to this work

Abstract: Food protein-induced enterocolitis syndrome (FPIES) is a potentially severe presentation of non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) with heterogeneous clinical manifestations. Acute FPIES is typically characterized by profuse vomiting and lethargy, occurring classically 1–4 hours after ingestion of the offending food. When continuously exposed to the incriminated food, a chronic form has been described with persistent vomiting, diarrhea, and/or failure to thrive. Although affecting mainly infants, FPIES has also been described in adults. Although FPIES is actually one of the most actively studied non-IgE-GI-FAs, epidemiologic data are lacking, and estimation of the prevalence is based on a limited number of prospective studies. The exact pathomechanisms of FPIES remain not well defined, but recent data suggest involvement of neutrophils and mast cells, in addition to T cells. There is a wide range of food allergens that can cause FPIES with some geographical variations. The most frequently incriminated foods are cow milk, soy, and grains in Europe and USA. Furthermore, FPIES can be induced by foods usually considered as hypoallergenic, such as chicken, potatoes or rice. The diagnosis relies currently on typical clinical manifestations, resolving after the elimination of the offending food from the infant’s/child’s diet and/or an oral food challenge (OFC). The prognosis is usually favorable, with the vast majority of the case resolving before 5 years of age. Usually, assessment of tolerance acquisition by OFC is proposed every 12–18 months. Of note, a switch to an IgE-mediated FA is possible and has been suggested to be associated with a more severe phenotype. Avoiding the offending food requires education of the family of the affected child. A multidisciplinary approach including ideally allergists, gastroenterologists, dieticians, specialized nurses, and caregivers is often useful to optimize the management of these patients, that might be difficult.

Keywords:
FPIES, FPIES management, FPIES diagnosis, non-IgE-mediated gastrointestinal food allergy, cow milk

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