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Food protein enterocolitis syndrome (FPIES) is an uncommon—and often under-recognised—type of food allergy, which generally presents in the first year of life, with tendency for remission in early childhood (although adults may also be affected, with increasing reports of adult FPIES appearing in the literature).1 In contrast to most infant food allergies, FPIES is not IgE-mediated and does not present with ‘typical’ IgE symptoms of skin pruritus and or features of anaphylaxis. Rather, it is characterised by onset of profuse vomiting, typically within 1–3 hours after ingestion of the trigger food, often accompanied by pallor, lethargy, hypothermia and diarrhoea. Although fatalities have not been reported, the ensuing hypovolaemia can be dramatic and intensive care admissions for supportive care are not uncommon. However, most episodes respond well to simple intravenous rehydration, and use of ondansetron, with longer term avoidance of trigger food/s. FPIES does not respond to intramuscular epinephrine.
FPIES is a clinical diagnosis, recently strengthened in case definition by publication of international consensus criteria.1 However, given the relatively non-specific presenting clinical features, it is often misdiagnosed as gastroenteritis, sepsis …
DEC and PJT contributed equally.
Contributors DC and PT jointly wrote this editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.