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Pediatr Allergy Immunol. 2014 Nov;25(7):622-9. doi: 10.1111/pai.12237. Epub 2014 May 23.

Food protein-induced enterocolitis syndrome: pitfalls in the diagnosis.

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Allergy Research Laboratory, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, 'Attikon' General University Hospital, Athens, Greece.


Food protein-induced enterocolitis syndrome (FPIES) represents the severe end of the spectrum of gastrointestinal food hypersensitivity; its acute episodes can culminate in severe dehydration and hypovolemic shock, and its chronic form entails considerable morbidity associated with feeding difficulty and failure to thrive. Nevertheless, awareness for this syndrome remains rather low. Many factors hamper the establishment of FPIES diagnosis. Such factors pertain to the pathophysiological mechanism of the syndrome, causal food proteins, clinical manifestations, diagnostic procedures, differential diagnosis considerations, and prevailing perceptions which may require critical appraisal. Throughout this review, we will present and discuss these issues and put the focus on factors that could lead to under-diagnosis of FPIES, cause numerous acute episodes, and substantially increase the diseases morbidity and financial burden. We will also address other issues that are clinically relevant to FPIES.


differential diagnosis; food allergy; food protein-induced enterocolitis syndrome; pediatrics; symptoms

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