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Adult Food Protein-Induced Enterocolitis Syndrome: A Review of Emerging Evidence and Clinical Considerations
Mehwish Ahmed1, Pavadee Poowuttikul2,3, William D Chey1
1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
Background:
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated reaction to food, well known in the allergy and immunology literature, that presents with delayed gastrointestinal symptoms. It is classically diagnosed in children and infants; however, new-onset cases have recently been identified in the adult population.
Summary:
There is a paucity of literature on FPIES in the gastroenterology literature. This review aimed to bring awareness to this entity as a possible etiology of gastrointestinal symptoms. Symptoms include abdominal pain, diarrhea, repetitive vomiting, and nausea, which occur 1 to 4 h after initial ingestion of food. In adult-onset cases, food triggers most often include seafood (fish, crustacean, and mollusk). Egg, wheat, and cow's milk have also been identified as triggers for adult-onset FPIES. Oral food challenge is the gold standard for diagnosis.
Key Messages:
This review provides an overview of the current literature on adult-onset FPIES. Adult and pediatric patients notably have different presentations of FPIES and different triggers. Providers should be aware of these distinctions when diagnosing this condition.
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