Food-protein-induced enterocolitis syndrome caused by fish

Area of Science:

• Pediatric Allergy and Immunology
• Gastroenterology
• Immunology

Background:

• Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food hypersensitivity typically seen in infants.
• While milk and soy are common triggers, FPIES can be induced by solid foods.
• This study focuses on FPIES specifically caused by fish protein.

Purpose of the Study:

• To report on a cohort of 14 infants diagnosed with FPIES due to fish protein.
• To describe the clinical presentation, diagnostic methods, and outcomes for these patients.
• To highlight the role of fish protein as a potential trigger for FPIES.

Main Methods:

• Patient history, physical examination, skin prick tests (SPT), prick-by-prick tests, and serum specific IgE antibody testing were performed.
• Atopy patch tests (APT) were conducted in some patients.
• Open oral food challenges (OC) were used to confirm diagnosis in nine infants.

Main Results:

• All 14 patients presented with FPIES symptoms after ingesting fish, with reactions ranging from vomiting to diarrhea and lethargy.
• SPT and serum specific IgE tests were largely negative, while APT was positive in three patients.
• Oral challenges confirmed fish as the trigger, and follow-up revealed that some patients developed tolerance or could tolerate specific types of fish.

Conclusions:

• Fish protein can cause FPIES, a non-IgE mediated hypersensitivity.
• Oral food challenge is the gold standard for diagnosis, but caution is advised.
• Tolerance to fish can develop after a period of dietary elimination.