Clinical features of food protein-induced enterocolitis syndrome.
OBJECTIVE
To describe the clinical characteristics of food protein-induced enterocolitis syndrome (FPIES), a symptom complex of severe vomiting and diarrhea occurring several hours after the ingestion of particular food proteins in infants.


METHODS
Retrospective review of a referral population.


RESULTS
Sixteen patients had typical FPIES; 11 reacted to milk, 11 to soy, and 7 to both. Mean age at diagnosis was 7 weeks for milk reactivity and 8 weeks for soy reactivity. Two patients also had rice- and pea-induced FPIES. Among 14 patients who were followed up for a median period of 25 months, loss of sensitivity to milk occurred in 6 of 10 patients and loss of sensitivity to soy occurred in 2 of 8. Six additional cases of FPIES were considered atypical: 1 patient had late-onset disease caused by poultry, and in 5 patients IgE antibody to milk or soy developed. During supervised food challenges with milk and soy, the peripheral blood neutrophil count rose over 3500 cells/mm3 in 9 of 10 positive challenges and did not rise above this value in the 7 negative challenges. Emergency treatment was required in 62% of challenges.


CONCLUSIONS
Although most patients with FPIES are infants reactive to milk and/or soy, this diagnosis should be considered in older children and for other foods. Food-specific IgE sensitivity may develop in some patients. Standardized food challenges are helpful for diagnosis and follow-up.
Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Mount Sinai Medical Center, New York, New York, USA.
S H
SH
Sicherer
P A
PA
Eigenmann
H A
HA
Sampson
D002648:Child; D002675:Child, Preschool; D004044:Dietary Proteins / Q000009:adverse effects*; D004760:Enterocolitis / Q000276:immunology*; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis; D012189:Retrospective Studies
D004044:Dietary Proteins