Abstract
A parent brings Henry, their 11-month-old son, to the GP surgery worried that he has had three short admissions to hospital in the past month with profuse vomiting and diarrhoea. They tell you Henry has each time become suddenly pale, floppy and lethargic and then vomited profusely. On two of the three occasions he’s gone on to have diarrhoea a few hours later. Each time they have been terrified and attended the emergency department (ED). Henry has either perked up in ED and been sent home or had a brief admission to the paediatric ward. When admitted to hospital he had blood tests, which they were told were normal. Henry was born at term by normal delivery, he is developing normally. He was exclusively breast fed until 6 months of age and is now weaned onto a mix of solids, breastfeeds and expressed breastmilk. They ask you if this could be some sort of allergy, as they have realised that every time this has happened has been 2–4 hours after eating fish, though he has previously had fish and been fine. You suspect that Henry has food protein induced enterocolitis syndrome (FPIES) and arrange a referral while advising they omit fish from his diet until he is seen. His parent asks you about the risk of anaphylaxis or death from this reaction and if it is safe to send him to nursery.
What are the most common trigger foods for FPIES? How do you respond to the question about anaphylaxis risk? What is the prognosis for this sort of non-immunoglobulin E (non-IgE) mediated food allergy?
