En pediatrisk kunskapslucka. FPIES - en icke-IgE-medierad födoämnesallergi med dramatiska symtom
Sammanfattning
Food protein-induced enterocolitis syndrome (FPIES) is a gastrointestinal, non-IgE-mediated, allergic disorder. The first cases were described about 40–50 years ago. Infants aged typically 4–12 months present about 2 hours after ingestion of milk, fish, or soy with vigorous vomiting, lethargy, pallor, and diarrhea. 20% of the cases may be associated with hypovolemic shock, and metabolic acidosis has been described. We present six cases with this disorder, three girls and three boys, aged 4–10 months at the time of their first episode of FPIES. Their reactions were triggered by cow’s milk (2 cases), soy, fish (2 cases), and chicken/turkey. All of them had typical symptoms with profuse vomiting, lethargy, and pallor. One of our patients developed metabolic acidosis. Two of our patients are atopic and have food-allergies, which are IgE-mediated (cow’s milk, egg, and wheat) with associated eczema and asthma.Emergency treatment of FPIES includes intravenous fluids and occasionally corticosteroids. Most patients develop tolerance by the age of three years. Challenge tests must be performed with caution.