title: Fruit-induced FPIES masquerading as hereditary fructose intolerance.
abstract: Hereditary fructose intolerance (HFI) symptoms develop at first introduction of fruit during weaning. We report on an infant with suspected HFI who presented with repeated episodes of vomiting and hypotension after ingestion of fruit-containing meals. The first episode occurred at age 4 months. Despite negative genetic testing for HFI, strict avoidance of fruit ingestion resulted in lack of recurrence of symptoms. Oral-fructose-tolerance testing conducted with an apple mousse did not determine hypoglycemia or fructosuria but caused severe hypotension. Allergy evaluations were negative, and the history was diagnostic for fruit-induced food protein-induced enterocolitis syndrome. Because this non-immunoglobulin E-mediated gastrointestinal food hypersensitivity manifests as profuse, repetitive vomiting, often with diarrhea, leading to acute dehydration and lethargy, it may be misinterpreted as HFI. We advise pediatricians to consider food protein-induced enterocolitis syndrome in the differential diagnosis when there is a suspicion of HFI.
authors.affiliation: Division of Allergy and alessandro.fiocchi@allegriallergia.net.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiocchi
authors.affiliation: Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Dionisi-Vici
authors.affiliation: Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cotugno
authors.affiliation: Division of Allergy and.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Koch
authors.affiliation: Division of Allergy and.
authors.forename: Lamia
authors.initials: L
authors.lastname: Dahdah
mesh_terms: D003937:Diagnosis, Differential; D004044:Dietary Proteins / Q000276:immunology; D004760:Enterocolitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D005633:Fructose Intolerance / Q000175:diagnosis*; D005638:Fruit; D006801:Humans; D007223:Infant; D008297:Male; D013577:Syndrome
chemical_list: D004044:Dietary Proteins
keywords: food hypersensitivity; food protein–induced enterocolitis syndrome; hereditary fructose intolerance; hypersensitivity; pediatrics