Diagnostic and Management Strategies of Food Protein-Induced Enterocolitis Syndrome: Current Perspectives

Figures & data

Table 1 Diagnostic Modality and Management for Acute and Chronic FPIES

Type	Diagnostic Modality	Management
Acute FPIES	Clinical history and recognition of symptoms OFC Step-wise approach	Elimination diet Step-wise approach
Chronic FPIES	Elimination diet Step-wise approach	Elimination diet Step-wise approach

Table 2 Clinical Characteristics of Infantile and Adult FPIES

Type	Clinical Symptoms
Infantile acute FPIES	Repetitive projectile vomiting For 1 to 4 hours (typically 2 hours of ingestion)
	Lethargy
	Hypotonia
	Pallor
	Hypothermia
	Diarrhea (within 6 to 8 hours of ingestion, or several days/weeks in severe cases)
	Persistent abdominal pain (in extreme cases)
Infantile chronic FPIES	Frequent watery diarrhea (occasionally with blood or mucous)
	Intermittent and progressively worsening vomiting
Adult FPIES	Severe abdominal pain
	Vomiting
	Diarrhea
	Loss of consciousness (In extreme cases)

Table 3 Step-Wise Approach to Elimination Diets and OFCs²⁹

Method	Steps
Elimination diet	Cow’s milk Egg Beef Wheat and nuts
OFC (Challenge begins with the last eliminated food item)	Cow’s milk Egg Beef Wheat Nuts

Table 4 Differential Diagnosis and Clinical History

Type	Condition	Diagnosis (Clinical History)
Acute FPIES	Sepsis	Fever Positive blood culture Weakness Vomiting Hyperpnea Tachycardia Neurological impairment Oliguria Hypotension
	Acute Dehydration	Fever Vomiting Diarrhea
	Necrotizing Enterocolitis	Instability Lethargy Vomiting Diarrhea Acidosis
Chronic FPIES	Celiac	Blood tests for anti-TTG Endoscopy with biopsy Diarrhea Abdominal distention Short stature Anemia Developmental delay

Uncuoğlu A, Aydoğan M, Şimşek IE, Çöğürlü MT, Uçak K, Acar HC. A prospective assessment of clinical characteristics and responses to dietary elimination in food protein–induced allergic proctocolitis. J Allergy Clin Immunol. 2022;10(1):206–214.e1. doi:10.1016/j.jaip.2021.10.048

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