title: Clinical management of food protein-induced enterocolitis syndrome.
abstract: OBJECTIVE
  The article discusses the clinical management of patients affected by food protein-induced enterocolitis syndrome (FPIES), focusing on established therapeutic choices and future options.
  
  
  RESULTS
  After FPIES has been diagnosed and avoidance of the culprit food prescribed, the most important management needs are as follows. First, recurrence of acute FPIES episodes due to accidental ingestion of culprit food. It may be useful to give patients' families an action plan. The principal suggested treatments are intravenous fluids and steroids, whereas the use of epinephrine and ondansetron requires further study. In mild-to-moderate cases, oral rehydration should be sufficient. Second, dietary introduction of at-risk foods. In children with FPIES, in addition to that/those identified as culprit(s), some foods may not be tolerated (typically cow's milk, legumes, cereals, poultry). It has been suggested to avoid introducing these foods during the baby's first year. Otherwise, they may be given for the first time in hospital, performing an oral food challenge. Third, acquisition of tolerance. Children affected by cow's milk-FPIES have a good chance of acquiring tolerance by the time they reach age 18-24 months. For other culprit foods, insufficient data are available to indicate the appropriate time, so that it is suggested that an oral food challenge be performed about 1  year after the last acute episode.
  
  
  CONCLUSIONS
  Future clinical management of FPIES must take into account, among other factors, improved understanding of pathogenesis, possible detection of different phenotypes, and the introduction of more effective therapies for acute episodes. These factors will undoubtedly influence management decisions, which will become more diversified and effective.
authors.affiliation: aDepartment of Pediatrics, Agostino Gemelli Hospital, Sacro Cuore Catholic University, Rome bDepartment of Pediatrics, Fatebenefratelli Hospital, Benevento cDepartment of Pediatrics, Regina Margherita Children's Hospital, University of Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Miceli Sopo
authors.forename: Iride
authors.initials: I
authors.lastname: Dello Iacono
authors.forename: Monica
authors.initials: M
authors.lastname: Greco
authors.forename: Giovanna
authors.initials: G
authors.lastname: Monti
mesh_terms: D002648:Child; D002675:Child, Preschool; D004044:Dietary Proteins / Q000009:adverse effects*; D004760:Enterocolitis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007223:Infant; D013577:Syndrome
chemical_list: D004044:Dietary Proteins