Food protein-induced enterocolitis syndrome
(Redirected from FPIES)
Background
- Non-IgE mediated immune reaction to food protein
- Peak incidence in infants 0-9 months
- Cow's milk and soy (in patient's diet or maternal diet if breast fed) are most common culprits
Clinical Features
- Acute reactions can cause life-threatening volume depletion
- Onset of symptoms ~1-6 hours after ingesting culprit (possibly reintroduced after period of not consuming)
- Profuse, repetitive vomiting and voluminous diarrhea
- Can lead to profound dehydration, shock, severe electrolyte abnormalities
- 75% of infants with FPIES appear seriously ill, with ~15% requiring hospitalization for hypotension[1]
- Symptoms may be mild-moderate if chronically exposed to offending food
- Chronic watery diarrhea with blood or mucus, vomiting, failure to thrive
Differential Diagnosis
Nausea and vomiting (newborn)
Newborn | ' |
Obstructive intestinal anomalies |
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Neurologic |
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Renal |
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Infectious | |
Metabolic/endocrine | |
Miscellaneous |
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Nausea and vomiting infant (<12 mo)
' | |
Obstructive intestinal anomalies |
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Neurologic |
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Renal |
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Infectious | |
Metabolic/endocrine | |
Miscellaneous |
- Overfeeding
- Starvation stools
- Short bowel syndrome
- Cystic fibrosis
- Celiac disease
- Disaccharidase deficiency
- Secretory neoplasms
- Immunodeficiency
- Inflammatory bowel disease
- Antibiotic-associated diarrhea
- Neonatal drug withdrawal
- Toxins
- Hemolytic uremic syndrome
Evaluation
- Clinical diagnosis
- Labs to assess for consequences of GI losses (e.g. BMP, Mg/Phos, VBG) +/- workup to exclude alternative diagnoses
Management
- Remove offending agent from diet (and maternal diet if patient breastfed)
- Volume resuscitation (see: dehydration (peds))
- Correct electrolyte abnormalities
- Antiemetics prn
- If severe[2] (e.g. intractable vomiting, ill-appearing, lethargic, hypotensive)
- Methylprednisolone 1mg/kg IV
- Epinephrine 0.01 mg/kg IM if shock/hypotension refractory to IV fluids
Disposition
- Admit if requires IV rehydration, electrolyte abnormalities, or intractable symptoms
See Also
External Links
References
- ↑ Nowak-wegrzyn A, Muraro A. Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2009;9(4):371-7.
- ↑ Current Treatment Options in Allergy. Jarock-Cyrta E, Valverde-Monge M, Nowak-Wegrzyn A. Management of Food Protein-Induced Enterocolitis Syndrome (FPIES): Current Approach and Future Needs. Current Treatment Options in Allergy 2017; 4:383