Table 1 Key features of FPIES, AP and FPE [1,2,3,4]
FPIES | AP | FPE | |
|---|---|---|---|
Typical age of onset | Days to 1 year; may be older in case of solid foods | Days to 6 months, usually 1–4 weeks; later onset in older children also reported | Dependent on age of exposure to antigen; CM and soy up to 2 years |
Food proteins implicated | |||
Most common | CM, soy | CM, soy | CM, soy |
Less common | Rice, oat, egg, barley, chicken, turkey, fish, pea | Wheat, egg, corn, meat, fish, sesame | Wheat, egg, soybean |
Symptoms | |||
Emesis | Prominent | Absent | Intermittent |
Diarrhea | Severe in chronic FPIES | Absent or mild | Moderate |
Bloody stools | Severe in chronic FPIES | Prominent | Rare |
Edema | Acute, severe | Mild, infrequent | Moderate |
Shock | 15–20% | Absent | Absent |
Failure to thrive | Moderate in chronic FPIES | Absent | Moderate |
Lethargy, pallor | Moderate | Absent | Absent |
Laboratory findings | |||
Anemia | Moderate | Mild, infrequent | Moderate |
Hypoalbuminemia | Acute | Mild, infrequent | Moderate |
Malabsorptionb | Absent | Absent | Present |
Leukocytosis with neutrophils | Prominent | Absent | Absent |
Allergy evaluation | |||
Food prick skin test | May be positive in 4–30%a | Negative | Negative |
Serum food-allergen IgE | May be positive in 4–30%a | Negative | Negative |
Total IgE | Normal or elevated | Normal or elevated | Normal |
Peripheral blood eosinophilia | Absent | Occasional | Absent |
Biopsy findings | |||
Villous injury | Patchy, variable | Absent | Variable, increased crypt length |
Colitis | Prominent | Focal | Absent |
Mucosal erosions | Occasional | Occasional, linear | Absent |
Lymphoid nodular hyperplasia | Absent | Common | Absent |
Eosinophils | Prominent | Prominent | Few |
OFC | Vomiting, lethargy, pallor in 1–6 h; diarrhea in 5–8 h | Rectal bleeding in 6–72 h | Vomiting and/or diarrhea in 40–72 h |