Poorly understood allergy: Academics highlight FPIES triggers, including rice and milk

By Gary Scattergood

- Last updated on GMT

The researchers noted there appears to be significant regional variations in common acute FPIES triggers. ©GettyImages
The researchers noted there appears to be significant regional variations in common acute FPIES triggers. ©GettyImages
Australian academics have drawn attention to 'poorly understood' food allergy — Food Protein-Induced Enterocolitis Syndrome (FPIES), which is often misdiagnosed in infants as sepsis or gastroenteritis.

The most common food triggers for FPIES are rice, cow’s milk, egg, oats and chicken.

FPIES typically presents between one and four hours after ingestion of the trigger food, with symptoms including profuse vomiting, pallor and lethargy. Other features can include hypotension, hypothermia, diarrhoea, neutrophilia and thrombocytosis.

Co-authors of a new narrative review, Dr Sam Mehr, a paediatric immunologist and allergist at Royal Melbourne Hospital, and Professor Dianne Campbell, Chair of Paediatric Allergy and Clinical Immunology at the University of Sydney, and Children’s Hospital, Westmead, noted:

“Diagnosis is often hampered by the lack of awareness of FPIES, absence of reliable biomarkers, the non-specific nature of the presenting symptoms, and the delay between allergen exposure and symptoms,”

“Although some national peak allergy bodies have attempted to improve the diagnosis and management of FPIES, up until 2017 there were no internationally agreed guidelines for its diagnosis and management,” ​they added.

Regional variations

No blood test exists for FPIES, and the treatment in an acute setting is fluid replacement, with ondansetron also believed effective. Long-term management involves confirming diagnosis via a food challenge, and “avoidance of identified trigger foods”.

The researchers also noted there appears to be significant regional variations in common acute FPIES triggers, with rice being the most common trigger in Australia, whereas cow’s milk is the commonest trigger in the United States and Europe. Soy FPIES is uncommon outside of the US.

They added there had been recent improvements is understanding, pointing out: Recent international consensus guidelines provide a more rigorous approach to diagnosis, introducing a system of major and minor criteria to facilitate early and accurate diagnosis and to guide diagnostic food challenge.

They concluded: “It is likely that improved understanding of the immunological basis of FPIES will, in the future, facilitate the development of a sensitive and specific biomarker. Until that time, use of standardised diagnostic criteria, improved recognition, timely fluid resuscitation, avoidance of trigger foods, and education form current best practice.”

Source: Medical Journal of Australia

“Food protein- induced enterocolitis syndrome: guidelines summary and practice recommendations”

Authors: ​Sam Mehr and Dianne E Campbell 

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