Clinical features of mild and severe acute Food protein–induced enterocolitis (FPIES)
Food protein–induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available.
Clinical features of mild and severe acute FPIES
|Mild-to-moderate acute FPIES||Severe acute FPIES|
|Laboratory features (optional, when available)||
Chronic FPIES is less well characterized compared with acute FPIES and only reported in infants younger than 4 months of age fed with cow’s milk (CM) or soy infant formula. Chronic FPIES develops on regular/repeated ingestion of the triggering food, presenting as chronic/intermittent emesis, watery diarrhea, and failure to thrive Severe chronic FPIES can lead to dehydration and shock. Hypoalbuminemia and poor weight gain can predict chronic CM-induced FPIES in young infants with chronic gastrointestinal symptoms. With elimination of the chronic FPIES food trigger or triggers, symptoms resolve, but subsequent feeding (accidental exposure or oral food challenge [OFC]) induces an acute FPIES reaction within 1 to 4 hours of food ingestion. The acute symptomatology after food avoidance distinguishes chronic FPIES from food protein–induced enteropathy, eosinophilic gastroenteritis, or celiac disease. Chronic FPIES is uncommon but appears to be diagnosed more frequently in Japan and Korea.
- International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. http://www.jacionline.org/article/S0091-6749(17)30153-7/fulltext#cebib0010
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