Food-protein-induced enterocolitis syndrome: the ‘anaphylaxis’ of non-IgE-mediated food allergy

FPIES (food-protein-induced enterocolitis syndrome) is a severe, non-IgE-mediated allergic reaction. Its hallmark is the onset of acute vomiting one to four hours post ingestion of a trigger food. Reactions can result in such significant hypovolaemia as to be end organ or life threatening and require prompt recognition and fluid support. FPIES is a disorder of infancy, and recent BPSU survey data suggests it is still under-recognized within the UK. Its presentation can mimic other more common conditions, such as sepsis and gastroenteritis, leading to under-recognition and diagnostic delay. Patients often end up experiencing multiple FPIES reactions before the diagnosis is reached. As it is a non-IgE-mediated condition, there is currently no diagnostic test available to confirm FPIES. Diagnosis therefore relies on awareness of the condition and accurate history taking. This article provides an overview of the epidemiology, diagnosis, and management of FPIES, and seeks to increase reader awareness and recognition of this rare but important form of food allergy.