Food protein–induced enterocolitis syndrome (FPIES) after multiple tolerant ingestions

Abstract

Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy. Acute FPIES reactions involve repetitive emesis 1 to 4 hours after food trigger ingestion and may be associated with lethargy, diarrhea, dehydration, hypotension, and metabolic derangements.1 Approximately 5% to 30% of patients with FPIES have specific IgE to the implicated food, termed atypical FPIES.2 The pathophysiology of FPIES remains poorly understood; a cell-mediated mechanism has been postulated. The phenotype of patients with persistent FPIES has not been well characterized but may involve multiple food triggers, atypical FPIES, seafood triggers, and/or more severe reactions.