Current and future perspectives on the consensus guideline for food protein-induced enterocolitis syndrome (FPIES)

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  • Anvari Sara
    Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital William T. Shearer Center for Human Immunobiology, Texas Children's Hospital
  • Ruffner Melanie A.
    Division of Allergy and Immunology, Children's Hospital of Philadelphia Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
  • Nowak-Wegrzyn Anna
    Division of Pediatric Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine Department of Pediatrics Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury

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<p>Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy presenting with delayed onset of projectile vomiting in the absence of cutaneous and respiratory symptoms. The pathophysiology of FPIES remains poorly characterized. The first international consensus guidelines for FPIES were published in 2017 and provided clinicians with parameters on the diagnosis and treatment of FPIES. The guidelines have served as a resource in the recognition and management of FPIES, contributing to an increased awareness of FPIES. Since then, new evidence has emerged, shedding light on adult-onset FPIES, the different phenotypes of FPIES, the recognition of new food triggers, center-specific food challenge protocols and management of acute FPIES. Emerging evidence indicates that FPIES impacts both pediatric and adult population. As a result, there is growing need to tailor the consensus guidelines to capture diagnoses in both patient groups. Furthermore, it is crucial to provide food challenge protocols that meet the needs of both pediatric and adult FPIES patients, as well as the subset of patients with atypical FPIES. This review highlights the evolving clinical evidence relating to FPIES diagnosis and management published since the 2017 International FPIES Guidelines. We will focus on areas where recent published evidence may support evolution or revision of the guidelines.</p>

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