Clinical features of food protein-induced enterocolitis syndrome (FPIES)

Chronic	Acute
Signs and symptoms
Intermittent, chronic vomiting Chronic, watery diarrhea with blood/mucus Lethargy Pallor Dehydration Abdominal distension Weight loss Failure to thrive	Repetitive vomiting every 10 to 15 minutes, onset 1 to 3 hours after ingestion (>90%) Diarrhea, onset approximately 5 hours after ingestion (<50%) Lethargy (70%) Pallor (70%) Dehydration Hypotension (15%) Hypothermia (25%) Abdominal distension
Laboratory findings
Anemia Hypoalbuminemia Elevated white count: - Left shift - Eosinophilia Metabolic acidosis Methemoglobinemia Stool-reducing substances Negative IgE test to the trigger food in most cases	Elevated neutrophil count Thrombocytosis Metabolic acidosis Methemoglobinemia Fecal leukocytes and eosinophils Frank or occult fecal blood Increased carbohydrate content in stool Elevated gastric juice leukocytes Negative IgE test to the trigger food in most cases
Radiologic features*
Air-fluid levels	Air-fluid levels

IgE: immunoglobulin E.
* Radiologic studies are not recommended for the diagnosis of FPIES, since there is no radiographic finding that is pathognomonic for FPIES. A few older studies, involving infants with possible FPIES symptoms including chronic diarrhea, rectal bleeding, and/or failure to thrive, reported air-fluid levels, nonspecific narrowing and thumb printing of the rectum and sigmoid, and thickening of the plicae circulares in the duodenum and jejunum with excess luminal fluid. Intramural gas has also been rarely documented, potentially leading to a misdiagnosis of necrotizing enterocolitis (NEC).

Graphic 87555 Version 8.0

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Clinical features of food protein-induced enterocolitis syndrome (FPIES)