Friend or foe? Figuring out the difference between FPIES, IgE-mediated allergy and food intolerance

Most physicians recognise the severe nature of the anaphylactic reactions associated with IgE-mediated food allergy. Adverse reactions to food involving non-IgE mechanisms are often less well understood and are often not diagnosed. Food protein-induced enterocolitis syndrome (FPIES) is an example of a severe non-IgE immune-mediated food reaction that is part of a spectrum of what is believed to be T-cell-mediated reactions. FPIES results in excessive emesis and diarrhoea hours after ingestion of the offending food. While common triggers include milk, soy, wheat and oat, some children may have multiple triggers, leading to malnutrition from lack of food options and unusual developmental concerns related to food aversion.