EC Paediatrics

Acute food protein-induced enterocolitis syndrome (FPIES) is a food-related gastrointestinal hypersensitivity disorder. It is classified as a non-IgE-mediated syndrome, but some atypical forms may have a slight IgE increase. It is characterized by repetitive vomiting within 1 - 4h after ingestion of a trigger food, in association with pallor, lethargy, diarrhea, hypotension or hypothermia. The current consensus guidelines of acute FPIES diagnosis requires an absence of classic IgE-mediated allergic skin or respiratory symptoms in this syndrome, but more evidence has surged that may contradict this initial definition. We present an unusual case of acute FPIES in a six-month-old infant, that besides the classic display, also includes a skin manifestation and a slight IgE positivity to the trigger food, potato. This case report highlights the need to review criteria for FPIES diagnosis.

Keywords: Diagnosis; Food Allergy; Food Protein Induced Enterocolitis Syndrome; Potato; Skin Manifestations

1. Nowak-Węgrzyn Anna., et al. “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 and Immunology”. The Journal of Allergy and Clinical Immunology 4 (2017): 1111-1126.e4.
2. Miceli Sopo S., et al. “A very unusual case of food allergy, between FPIES and IgE-mediated food allergy”. European Annals of Allergy and Clinical Immunology 1 (2017): 42-44.
3. Miceli Sopo S., et al. “Is food protein induced enterocolitis syndrome only a non IgE-mediated food allergy?”. Allergologia et Immunopathologia 5 (2018): 499-502.
4. Miceli Sopo Stefano., et al. “Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions”. Medicina6 (2019): 216.
5. Serafini Séverine., et al. “A case of food protein-induced enterocolitis syndrome to mushrooms challenging currently used diagnostic criteria”. The Journal of Allergy and Clinical Immunology. In Practice 1 (2015): 135-137.
6. Banzato C., et al. “Unusual shift from IgE-mediated milk allergy to food protein-induced enterocolitis syndrome”. European Annals of Allergy and Clinical Immunology 6 (2013): 209-211.
7. Leonard Stephanie A., et al. “Food protein-induced enterocolitis syndrome: a review of the new guidelines”. The World Allergy Organization Journal 1 (2018): 4.
8. Mastrorilli Carla., et al. “New insights into food protein-induced enterocolitis in children”. Minerva Pediatrica 5 (2020): 416-423.