FPIES may progress to IgE-mediated food allergy

Published Online: May 28, 2014

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that manifests with profuse vomiting and lethargy within 1-3 hours following food ingestion; up to 15% of those affected may develop shock. FPIES diagnosis is frequently delayed due to the absence of classic allergic symptoms and lack of biomarkers.

In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Caubet and colleagues reported characteristics of patients with FPIES who were prospectively recruited for oral food challenges (OFC).

Among 160 subjects, 54% were male; median age at diagnosis was 15 months. The most common foods causing an allergic reaction were cow’s milk (44%), soy (41%), rice (22.5%), and oat (16%). The majority (65%) reacted to one food, 26% reacted to two foods, and 9% reacted to multiple foods. The majority of patients were atopic; 39% had IgE-testing positive to another food. Thirty-nine subjects (24%) had positive specific-IgE to the food inducing FPIES. Among children who developed specific IgE to cow’s milk, 35% changed from a milk-FPIES to an IgE-mediated phenotype over time. The median age when tolerance was established was 4.7 years for rice, 4 years for oat, and 6.7 years for soy. Median age when milk-tolerance was established for subjects with undetectable milk-IgE was 5.1 years, whereas none of the subjects with detectable milk-specific IgE became tolerant to milk during the study, P=0.003.

Food Protein-Induced Enterocolitis Syndrome (FPIES) typically resolves by age 6 years, but milk FPIES, especially with detectable food-specific IgE, may have a protracted course and eventually transition to acute reactions/anaphylaxis.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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