Advances in understanding immune mechanisms of food protein-induced enterocolitis syndrome

This review provides an overview of our current understanding of the mechanisms of food protein-induced enterocolitis syndrome (FPIES).

To capture recent articles published since our previous comprehensive review on the pathophysiology of FPIES, we performed a literature search through PubMed database, using the search terms FPIES and food protein-induced enterocolitis syndrome from 2016 to the current year.

Studies in English containing biomarker or immune data were reviewed and summarized.

Studies of peripheral blood fail to exhibit evidence of antigen-specific humoral or cellular immunity underlying clinical reactivity to foods in FPIES. However, growing evidence suggests a robust systemic innate immune activation occurring during FPIES reactions and the activation of neuroendocrine pathways.

FPIES reactions are associated with marked activation of innate immune and neuroendocrine pathways; however, the mechanism underlying the specific recognition of foods remains elusive.