Poorly understood food allergy under microscope

Cate Swannell
Med J Aust
Published online: 20 January 2019

AWARENESS of a “poorly understood” food allergy, often misdiagnosed in infants as sepsis or gastroenteritis, has been boosted by the publication of a narrative review in the Medical Journal of Australia.

Food protein induced enterocolitis syndrome, or FPIES, typically presents between 1 and 4 hours after ingestion of the trigger food, with symptoms including profuse vomiting, pallor and lethargy. Other features can include hypotension, hypothermia, diarrhoea, neutrophilia and thrombocytosis.

Co-authors of the narrative review, Dr Sam Mehr, a paediatric immunologist and allergist at Royal Melbourne Hospital, and Professor Dianne Campbell, Chair of Paediatric Allergy and Clinical Immunology at the University of Sydney, and Children’s Hospital, Westmead, wrote that in Australia the most common food triggers for FPIES were, in descending order, rice, cow’s milk, egg, oats and chicken.

“Diagnosis is often hampered by the lack of awareness of FPIES, absence of reliable biomarkers, the non-specific nature of the presenting symptoms, and the delay between allergen exposure and symptoms,” Mehr and Campbell wrote.

No blood test exists for FPIES, and the treatment in an acute setting is fluid replacement, with ondansetron also believed effective. Long-term management involves confirming diagnosis via a food challenge, and “avoidance of identified trigger foods”.

“It is likely that improved understanding of the immunological basis of FPIES will, in the future, facilitate the development of a sensitive and specific biomarker,” Mehr and Campbell concluded. “Until that time, use of standardised diagnostic criteria, improved recognition, timely fluid resuscitation, avoidance of trigger foods, and education form current best practice.”

  • Cate Swannell



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