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


RESULTS
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 degrees 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.


CONCLUSIONS
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 TNFalpha 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.
Nowak-Wegrzyn
Anna
A
Jaffe Food Allergy Institute, Department of Pediatrics, Mount Sinai School of Medicine, Division of Allergy and Immunology, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA. anna.nowak-wegrzyn@mssm.edu
Muraro
Antonella
A
D000485:Allergens / Q000276:immunology*; D000818:Animals; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002648:Child; D003888:Desensitization, Immunologic; D003937:Diagnosis, Differential; D004760:Enterocolitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D005440:Fluid Therapy; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008892:Milk / Q000276:immunology; D030262:Soybean Proteins / Q000276:immunology; D013025:Glycine max / Q000276:immunology; D014774:Virulence
D000485:Allergens; D030262:Soybean Proteins