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

Differential Diagnosis

Nausea and vomiting (newborn)

Newborn '
Obstructive intestinal anomalies
Neurologic
Renal
Infectious
Metabolic/endocrine
Miscellaneous

Nausea and vomiting infant (<12 mo)

'
Obstructive intestinal anomalies
Neurologic
Renal
Infectious
Metabolic/endocrine
Miscellaneous

Evaluation

  • Clinical diagnosis
  • Labs to assess for consequences of GI losses (e.g. BMP, Mg/Phos, VBG) +/- workup to exclude alternative diagnoses

Management

Disposition

  • Admit if requires IV rehydration, electrolyte abnormalities, or intractable symptoms

See Also

External Links

References

  1. Nowak-wegrzyn A, Muraro A. Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2009;9(4):371-7.
  2. 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

Authors:

Claire