RATIONALE: FPIES is non-immediate type gastrointestinal allergy affecting neonates and infants. Since 1995, incidence rate of FPIES has been elevated in Japan. Sometimes, clinical signs are non-specific and vague. Specific IgE to milk protein is not detected in many patients. Diagnosis is not easy and delay of the treatment can lead to serious complications. We performed multi-center case-series study and intended to establish up-to date recommendations for diagnosis and treatment.
METHODS: Inclusion criteria were to fulfill at least 1-4 of those 5 steps for diagnosis. 1) Suspicion of FPIES based on symptoms, 2) Differential diagnosis from other disorders based on laboratory examinations, 3) Switch to therapeutic milk and resolution of the symptoms, 4) Verify body weight gain every month, 5) Challenge test to confirm diagnosis. Japanese Research Group experienced 114 patients and reviewed clinical and laboratory data.
RESULTS: Mean date of the onset was 5.2 days after birth. Symptoms at onset were vomiting (35%), bloody stool (36%) and diarrhea (8%). High eosinophil count (more than 20%) in peripheral blood was seen in 50% of the patients. Stool eosinophil was seen in 69%. Lymphocyte stimulation test to milk protein was positive in 73%. Specific IgE to milk protein was detected only in 47% of the patients.
Eosinophilic inflammation was prominent in FPIES. But still confirmative diagnosis is not easy. If suspected, change of formula is recommended not to lead serious complications. (Home page address of our recommendations for diagnosis and treatment; http://www.nch.go.jp/imal/FPIES/FPIES_eng.htm
© 2009 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.