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Table 1 Key features of FPIES, AP and FPE [1,2,3,4]

From: Non-IgE-mediated food hypersensitivity

  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
  1. Adapted from Feuille and Nowak-Węgrzyn [1], Caubet et al. [2], Nowak-Wegrzyn [3], Nowak-Wegrzyn et al. [4]
  2. CM cow’s milk, FPIES food protein-induced enterocolitis syndrome, AP allergic proctocolitis, FPE food protein-induced enteropathy, IgE immunoglobulin E, OFC oral food challenge
  3. aIf positive, might be a risk factor for persistent disease
  4. bMalabsorption, steatorrhea, sugar malabsorption, and deficiency of vitamin K-dependent factors can be seen
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Allergy, Asthma & Clinical Immunology

ISSN: 1710-1492

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