A CASE OF ACUTE FOOD PROTEIN-INDUCED ENTEROCOLITIS (FPIES) TO FISH, TURKEY, AND DUCK

Abstract

<h3>Introduction</h3> FPIES is a non-IgE mediated food allergy characterized by delayed vomiting after ingestion of a causal food. We present a case of FPIES to fish, turkey, and duck, suggesting cross-reactivity. <h3>Case Description</h3> The patient had two episodes of delayed vomiting following cod ingestion. The first occurred at age 2.5 yrs resulting in severe vomiting 2 hours after, requiring IV fluids. A second cod reaction occurred months later, with vomiting 3-4 hours following ingestion. He had previously tolerated various types of fish, including cod, but stopped ingestion of all fish after these reactions. At age 4 yrs the patient experienced abdominal pain, diarrhea, and repetitive vomiting 4 hours after eating turkey. He had previously tolerated turkey with his last exposure being 6 months prior. When 6 years old, the patient had severe, repetitive vomiting 4 hours after duck ingestion on 2 occasions. He continues to tolerate chicken. Skin prick testing was negative to cod, turkey, and duck, consistent with a diagnosis of FPIES. The patient was instructed to avoid all types of fish, and turkey/duck. <h3>Discussion</h3> There is limited information on the cross-reactivity of allergens in FPIES. Fish-chicken syndrome is described in IgE-mediated food allergies, attributed to homologous proteins parvalbumin, aldolase, and enolase. We hypothesize that these proteins may have a similar role in the pathogenesis of FPIES via an activation of T lymphocytes in our patient. Duck is an uncommon poultry meat and it is possible that those with FPIES to turkey may have an increased risk of reacting to duck.