title: Non-IgE-mediated gastrointestinal food allergy.
abstract: Non-IgE-mediated gastrointestinal food-induced allergic disorders (non-IgE-GI-FAs) account for an unknown proportion of food allergies and include food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). Non-IgE-GI-FAs are separate clinical entities but have many overlapping clinical and histologic features among themselves and with eosinophilic gastroenteropathies. Over the past decade, FPIES has emerged as the most actively studied non-IgE-GI-FA, potentially because of acute and distinct clinical features. FPIAP remains among the common causes of rectal bleeding in infants, while classic infantile FPE is rarely diagnosed. The overall most common allergens are cow's milk and soy; in patients with FPIES, rice and oat are also common. The most prominent clinical features of FPIES are repetitive emesis, pallor, and lethargy; chronic FPIES can lead to failure to thrive. FPIAP manifests with bloody stools in well-appearing young breast-fed or formula-fed infants. Features of FPE are nonbloody diarrhea, malabsorption, protein-losing enteropathy, hypoalbuminemia, and failure to thrive. Non-IgE-GI-FAs have a favorable prognosis; the majority resolve by 1 year in patients with FPIAP, 1 to 3 years in patients with FPE, and 1 to 5 years in patients with FPIES, with significant differences regarding specific foods. There is an urgent need to better define the natural history of FPIES and the pathophysiology of non-IgE-GI-FAs to develop biomarkers and novel therapies.
authors.affiliation: Jaffe Food Allergy Institute, Division of Pediatric Allergy, Mount Sinai School of Medicine, New York, NY. Electronic address: anna.nowak-wegrzyn@mssm.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Nowak-Węgrzyn
authors.affiliation: Allergy and Immunology Institute, Assaf Harofeh Medical Center, Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Katz
authors.affiliation: Department of Allergy and Immunology, Children's Hospital at Westmead, Westmead, Australia.
authors.forename: Sam Soheil
authors.initials: SS
authors.lastname: Mehr
authors.affiliation: Division of Gastroenterology and Hepatology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
mesh_terms: D000818:Animals; D001942:Breast Feeding; D019468:Disease Management; D005260:Female; D005502:Food / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007223:Infant; D015995:Prevalence
chemical_list: D007073:Immunoglobulin E
keywords: Food protein–induced enterocolitis syndrome; allergic proctocolitis; food allergy; food protein–induced enteropathy; non–IgE-mediated food allergy