Dietary protein induced enterocolitis syndrome

Powell, 1978

Not -IgE- but cell-mediated food allergy (Nowak-Węgrzyn A et al. 2017) which occurs in infants in the first weeks of life and which sets in 1-4 hours after ingestion (Leonard SA et al. 2015). The entity of the clinical picture is still controversial insofar as well-founded clinical studies on this clinical picture are still missing (Nowak-Węgrzyn A et al. 2017).

Reliable data are not available. Incidences of 3/1000 newborns are given (Katz et al 2011).

Pathogenesis is unclear. Food-induced TNF-alpha release from mononuclear cells is being discussed. The symptoms are primarily triggered by cow's milk or soy products (Caubet JC et al. (2014).

In the first months of life

Acute FPIES manifests itself within 1-4 hours after food intake with irritability, persistent vomiting, watery or mucous, sometimes bloody diarrhoea, dehydration and possibly hypovolemic shock.

The chronic FPIES is less well characterized (Nowak-Węgrzyn A et al. 2017). It occurs in infants <4 months of age who are fed on cow's milk or soy products. Chronic FPIES is characterized by intermittent vomiting, watery diarrhea, and decreased growth. A severe course leads to dehydration, hypalbuminemia, hypovolemic shock over a period of days or weeks. After the trigger factors are eliminated, clinical symptoms resolve. Later dietary errors lead to clinical symptoms of acute FPIES.

Is asked on the basis of clinical history and symptoms. Skin tests are negative.

Avoidance of the triggering food. In general, the symptoms improve after 1-2 years (Jäger L 2001). However, they can also persist into the school years. In older children, enterocolitis is in the foreground. The accused food spectrum is broader at this age. It includes poultry, beef, legumes (peanuts, green peas, lentils), chicken eggs, vegetables and fruits (potato, sweet potato, banana, apple).

The development of a tolerance towards the accused food was reported over a period of 35 -42 months. In a larger Israeli study, 60% of the children showed tolerance after 1 year, 75% after 2 years and 85% after 3 years (Katz Y et al. 2011).

1. Caubet JC et al (2014) Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol 134: 382-389
2. Jäger L et al (2001) Food allergies and intolerances. Urban & Fischer Publishing House Munich, Jena S 67-68
3. Katz Y et al (2011) The prevalence and natural course of food protein-induced enterocolitis syndrome to cow's milk: a large-scale, prospective population-based study J Allergy Clin Immunol, 127: 647-653
4. Leonard SA et al (2015) Food Protein-Induced Enterocolitis Syndrome. Pediatr Clin North Am 62:1463-1477.
5. Nowak-Węgrzyn A et al (2017) Food Protein-Induced Enterocolitis Syndrome. J Investig Allergol Clin Immunol 27:1-18.
6. Nowak-Węgrzyn A et al. (2017) International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 139:1111-1126.