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J Allergy Clin Immunol Pract. 2013 Jul-Aug;1(4):317-22. doi: 10.1016/j.jaip.2013.04.004. Epub 2013 May 31.

Food protein-induced enterocolitis syndrome (FPIES): current management strategies and review of the literature.

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Division of Allergy and Immunology, Albany Medical College, Albany, NY. Electronic address:
Division of Pediatric Allergy & Immunology and Jaffe Institute for Food Allergy, The Mount Sinai School of Medicine, New York, NY.


Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity that manifests as profuse, repetitive vomiting, often with diarrhea, leading to acute dehydration and lethargy or weight loss and failure to thrive if chronic. FPIES is elicited most commonly by milk and soy proteins; however, rice, oat, and other solid foods may also elicit FPIES. Certain FPIES features overlap with food protein-induced enteropathy and proctocolitis, whereas others overlap with anaphylaxis. FPIES is not well recognized among pediatricians and emergency department physicians; the affected children are often mismanaged as having acute viral gastrointestinal illness, sepsis, or surgical disease, delaying diagnosis of FPIES for many months. The aim of this review is to provide case-driven presentation of the features of FPIES. Although randomized clinical trials on management options are missing, the relevant current literature and authors' experience are reviewed in detail.


Cow's milk; Enterocolitis; Food allergy; Food protein-induced enterocolitis; Food-induced; Gastrointestinal; Multiple foods; Solid food; Soy

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