Food protein induced enterocolitis syndrome (FPIES): A Time to Define
FPIES is a relatively poorly defined entity, with an unknown prevalence, despite its being described over half a half a century ago. Patients with this disease have repetitive vomiting and often lethargy following the ingestion of foods. It is commonly misdiagnosed and often these infants are treated for presumed infections or metabolic disorders.
In a study published in the March 2011 issue of The Journal of Allergy and Clinical Immunology (JACI), Katz et al. for the first time performed a prospective study on the allergic reactions to milk and defined the prevalence of FPIES to milk to be approximately 0.3% (half of the incidence of IgE-mediated cow's milk allergy). Important features of the disease which they confirmed include the high rate of recovery and the importance of performing an oral food challenge for diagnosis.
Two unexpected results were the low rate of cross-sensitization to soy, which has commonly been believed to be between 30-40%, and the relatively high development of IgE-mediated cow's milk allergy in these patients (approximately 20%). The latter emphasizes the importance of reintroducing milk to these patients in the presence of medical personnel in a secure and controlled environment. Finally, it is suggested that diarrhea should not be part of the definition since it occurred in only a minority of the patients.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.