Food protein induced enterocolitis
11 min read
/
FPIES – an overview
With a cumulative incidence of 0.015 % to 0.7% in infants, food protein induced enterocolitis (FPIES) is not uncommon. An up-todate overview of epidemiology, pathophysiology, diagnosis and management.
FPIES (= food protein-induced enterocolitis syndrome) is a non-IgE-mediated food allergy that manifests itself with repeated, erratic vomiting, which can be followed by diarrhoea and is accompanied by lethargy, hypotension, hypothermia, and metabolic disorders.
FPIES usually begins in childhood, usually with the beginning of supplementary feeding, although increasingly a beginning at a higher age is also recognised. Diagnosis is challenging because of a delay in the onset of symptoms after food intake of 1 to 4 hours, the absence of the typical allergic skin and respiratory symptoms and food triggers that are considered hypoallergenic. Because there are no biomarkers for FPIES, diagnosis is based on the recognition of symptoms. The pathophysiology remains unclear, although the activation of the innate immune response has been demonstrated.
Management is based on the avoidance of triggers, the treatment of unintentional exposures and periodic reassessment by oral provocation. There are no strategies to accelerate the development of tolerance in FPIES.
Nowak-Wegrzyn A et al., J Allergy Clin Immunol Pract 2020
Questions about the Nature of FPIES
Non-IgE-mediated food protein induced enterocolitis (FPIES) mainly affects young infants. The most common triggers are milk, soy and cereals. Studies evaluating the natural course of FPIES show heterogeneous tolerance levels.
Several factors influence these differences, including country of origin, food triggers, atopic status, reference populations and methodological differences in the studies.
FPIES to liquids (cow‘s milk and soya food) has a generally favourable course, most patients develop tolerance up to the age of 5 years, with solid food the tolerance development usually occurs later.
The subgroup of patients with atypical FPIES – i.e. with a positive specific IgE associated with the suspect foods - might have a more severe phenotype and slower tolerance development. Also, an increased risk could be due to an IgE-mediated phenotype.
Further multicentre and prospective studies are needed to better determine the natural course of FPIES in individual foods, to determine the optimal time of food introduction and to clarify the risk factors associated with persistent FPIES.
Graham F et al., in: Brown-Whitehorn T, Cianferoni A (eds), 2019
With a cumulative incidence of 0.015 % to 0.7% in infants, food protein induced enterocolitis (FPIES) is not uncommon. An up-todate overview of epidemiology, pathophysiology, diagnosis and management.
FPIES (= food protein-induced enterocolitis syndrome) is a non-IgE-mediated food allergy that manifests itself with repeated, erratic vomiting, which can be followed by diarrhoea and is accompanied by lethargy, hypotension, hypothermia, and metabolic disorders.
FPIES usually begins in childhood, usually with the beginning of supplementary feeding, although increasingly a beginning at a higher age is also recognised. Diagnosis is challenging because of a delay in the onset of symptoms after food intake of 1 to 4 hours, the absence of the typical allergic skin and respiratory symptoms and food triggers that are considered hypoallergenic. Because there are no biomarkers for FPIES, diagnosis is based on the recognition of symptoms. The pathophysiology remains unclear, although the activation of the innate immune response has been demonstrated.
Management is based on the avoidance of triggers, the treatment of unintentional exposures and periodic reassessment by oral provocation. There are no strategies to accelerate the development of tolerance in FPIES.
Nowak-Wegrzyn A et al., J Allergy Clin Immunol Pract 2020
Questions about the Nature of FPIES
Non-IgE-mediated food protein induced enterocolitis (FPIES) mainly affects young infants. The most common triggers are milk, soy and cereals. Studies evaluating the natural course of FPIES show heterogeneous tolerance levels.
Several factors influence these differences, including country of origin, food triggers, atopic status, reference populations and methodological differences in the studies.
FPIES to liquids (cow‘s milk and soya food) has a generally favourable course, most patients develop tolerance up to the age of 5 years, with solid food the tolerance development usually occurs later.
The subgroup of patients with atypical FPIES – i.e. with a positive specific IgE associated with the suspect foods - might have a more severe phenotype and slower tolerance development. Also, an increased risk could be due to an IgE-mediated phenotype.
Further multicentre and prospective studies are needed to better determine the natural course of FPIES in individual foods, to determine the optimal time of food introduction and to clarify the risk factors associated with persistent FPIES.
Graham F et al., in: Brown-Whitehorn T, Cianferoni A (eds), 2019
