Chocolate-associated FPIES
Question:
3/13/2019
Have there been any reported cases of FPIES due to chocolate? I have a 4 year-old patient who has had forceful vomiting two or three tmes with some lethargy/fatigue starting 90 to 120 minutes after chocolate ingestion on seven occasions. This only occurs after eating chocolate and only starts 90 to 120 minutes after chocolate ingestion. No problems from soy, milk, egg, rice, oat or any other food - just chocolate. No hives, swelling, respiratory symptoms or symptoms other than the vomiting leading to some lethargy on the seven occasions she ate chocolate. I've not heard of FPIES from chocolate but this sounds like it. Your thoughts?
Answer:
I have not heard of any cases of FPIES associated with chocolate and I could not find any cases reported to date. Unsweetened chocolate is 45 to 55% fat and 10 to 15% protein, so it may be possible to have FPIES against the protein in chocolate. That said, avoidance is the treatment of choice for FPIES with any cause and there is no particular harm in avoiding chocolate. In 2-3 years it might be reasonable to rechallenge.
I hope this information is of help to you and your patient.
Regards,
Eric Macy, MD, MS, FAAAAI