Update on Food Protein–Induced Enterocolitis Syndrome (FPIES)

Purpose of Review Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this c...

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Bibliographic Details
Published in:Current allergy and asthma reports 2022-10, Vol.22 (10), p.113-122
Main Authors: Baker, Mary Grace, Cecilia Berin, M., Sicherer, Scott
Format: Article
Language:English
Subjects:
Allergology
Asthma
Diagnostic tests
Electrolytes
Food allergies
Hypotension
Immunology
Laboratories
Medicine
Medicine & Public Health
Pathophysiology
Patients
Pediatric Allergy and Immunology (W Dolen
Pediatrics
Proteins
Rice
Section Editor
Topical Collection on Pediatric Allergy and Immunology
Vomiting
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Summary:Purpose of Review Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this condition has grown. Recent Findings FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability. Management involves trigger avoidance, and patients may benefit from the support of a dietitian to ensure adequate nutrient intake. Tolerance develops over time for most children, but due to the risk of severe symptoms, re-introduction of a suspected FPIES trigger is recommended only under supervision at an oral food challenge. Studies continue to evaluate the optimal challenge protocol. Caregivers of children with FPIES report high levels of anxiety and stress, which is attributed to the dramatic symptomatology, dietary restrictions, nutritional concerns, lack of confirmatory diagnostic tests, and limited tools for management of reactions. Summary Our understanding of the FPIES diagnosis has improved over the last few decades, but there remain opportunities, particularly regarding discerning the pathophysiology and best management practices.
ISSN:1529-7322
1534-6315
DOI:10.1007/s11882-022-01037-y