Acute Food Protein-Induced Enterocolitis Syndrome Selectively Induced by Durum Wheat: A Case Report

Food protein-induced enterocolitis syndrome (FPIES) can be triggered by wheat; however, whether clinical reactivity differs among wheat species remains unclear. We report a child who developed reproducible delayed vomiting after ingestion of pasta made from durum wheat at one year of age, while tolerating comparable amounts of other common wheat-based foods such as bread and noodles. An oral food challenge (OFC) confirmed the diagnosis despite incomplete fulfillment of consensus criteria. The patient subsequently achieved tolerance, as demonstrated by a negative follow-up OFC. This case suggests that wheat species-specific differences in antigenicity may influence clinical reactivity in FPIES. When clinical history raises the possibility that reactions differ according to specific wheat species, clinicians should not hesitate to perform species-specific OFCs with the relevant wheat sources. Such an approach is important to establish an accurate diagnosis and to avoid unnecessary dietary elimination. In addition, OFC is important not only for establishing the diagnosis but also for confirming tolerance acquisition.