Purpose Of Review: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed, and potentially severe, gastrointestinal symptoms. Since the advent of a specific diagnostic code and establishment of diagnostic guidelines, our understanding of this condition has grown.
Recent Findings: FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability. Management involves trigger avoidance, and patients may benefit from the support of a dietitian to ensure adequate nutrient intake. Tolerance develops over time for most children, but due to the risk of severe symptoms, re-introduction of a suspected FPIES trigger is recommended only under supervision at an oral food challenge. Studies continue to evaluate the optimal challenge protocol. Caregivers of children with FPIES report high levels of anxiety and stress, which is attributed to the dramatic symptomatology, dietary restrictions, nutritional concerns, lack of confirmatory diagnostic tests, and limited tools for management of reactions. Our understanding of the FPIES diagnosis has improved over the last few decades, but there remain opportunities, particularly regarding discerning the pathophysiology and best management practices.
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http://dx.doi.org/10.1007/s11882-022-01037-y | DOI Listing |
J Allergy Clin Immunol Pract
January 2025
Department of Pediatrics, Seirei Numazu Hospital, 902-6, Matsushitahichitanda, Numazu City, Shizuoka 410-0867, Japan. Electronic address:
J Allergy Clin Immunol Pract
January 2025
Section of Inflammation, Repair and Development, National Heart and Lung Institute. Imperial College London, UK.
Background: Evidence on the role of IgE sensitisation in acute Food Protein-Induced Enterocolitis Syndrome ('atypical FPIES') is limited. Initial reports claimed association with persistent disease, however recent studies have not replicated this.
Objective: To systematically review the relationship between sensitisation to the culprit food(s) in acute FPIES and the outcome of follow-up oral food challenges.
J Allergy Clin Immunol Glob
February 2025
the Department of Pediatrics, New York University Grossman School of Medicine, New York, NY.
Background: Management of patients with food allergies is complex, especially in cases of patients with multiple and potentially severe food allergies. Although international guidelines exist for food allergy management, the role of the allergist in the decision-making process is key.
Objective: Our aim was to investigate the management patterns and educational needs of practicing allergists treating patients with food allergies.
J Allergy Clin Immunol Pract
January 2025
Pediatric Allergy Unit, Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy. Electronic address:
Background: Reintroduction of offending food in pediatric patients affected by Food Protein-Induced Enterocolitis Syndrome (FPIES) is carried out in hospitals with Oral Food Challenge (OFC), which leads to long waiting time and increases the societal burden of medical cost and human resources.
Objective: The aim of the study is to assess severity trend of acute FPIES adverse reactions over time in the same patient for possible outpatient or home reintroduction of offending food.
Methods: All children (<18 years-old) with a diagnosis of acute FPIES referred to 2 Italian pediatric allergy clinics were retrospectively enrolled.
J Investig Allergol Clin Immunol
January 2025
Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
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