Ver el código de «Food protein-induced enterocolitis syndrome»

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==Background==

*Non-IgE mediated immune reaction to food protein
*Peak incidence in infants 0-9 months
*Cow's milk and soy (in patient's diet or maternal diet if breast fed) are most common culprits


==Clinical Features==

*Acute reactions can cause life-threatening volume depletion
**Onset of symptoms ~1-6 hours after ingesting culprit (possibly reintroduced after period of not consuming)
**Profuse, repetitive [[Special:MyLanguage/nausea and vomiting (peds)|vomiting]] and voluminous [[Special:MyLanguage/diarrhea (peds)|diarrhea]]
**Can lead to profound [[Special:MyLanguage/dehydration (peds)|dehydration]], [[Special:MyLanguage/shock|shock]], severe [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]]
**75% of infants with FPIES appear seriously ill, with ~15% requiring hospitalization for hypotension<ref>Nowak-wegrzyn A, Muraro A. Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2009;9(4):371-7.</ref>
*Symptoms may be mild-moderate if chronically exposed to offending food
**Chronic watery [[Special:MyLanguage/diarrhea (peds)|diarrhea]] with blood or mucus, [[Special:MyLanguage/nausea and vomiting (peds)|vomiting]], [[Special:MyLanguage/failure to thrive (peds)|failure to thrive]]


==Differential Diagnosis==

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*Overfeeding 
*Starvation stools
*Short bowel syndrome
*[[Special:MyLanguage/Cystic fibrosis|Cystic fibrosis]] 
*[[Special:MyLanguage/Celiac disease|Celiac disease]]
*Disaccharidase deficiency 
*Secretory neoplasms
*Immunodeficiency 
*[[Special:MyLanguage/Inflammatory bowel disease|Inflammatory bowel disease]] 
*[[Special:MyLanguage/Antibiotic|Antibiotic]]-associated diarrhea 
*[[Special:MyLanguage/neonatal abstinence syndrome|Neonatal drug withdrawal]] 
*[[Special:MyLanguage/Toxins|Toxins]] 
*[[Special:MyLanguage/Hemolytic uremic syndrome|Hemolytic uremic syndrome]]


==Evaluation==

*Clinical diagnosis
*Labs to assess for consequences of GI losses (e.g. BMP, Mg/Phos, [[Special:MyLanguage/VBG|VBG]]) +/- workup to exclude alternative diagnoses


==Management==

*Remove offending agent from diet (and maternal diet if patient breastfed)
*Volume resuscitation (see: [[Special:MyLanguage/dehydration (peds)|dehydration (peds)]])
*Correct [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]]
*[[Special:MyLanguage/Antiemetics|Antiemetics]] prn
*If severe<ref>Current Treatment Options in Allergy. Jarock-Cyrta E, Valverde-Monge M, Nowak-Wegrzyn A. Management of Food Protein-Induced Enterocolitis Syndrome (FPIES): Current Approach and Future Needs. Current Treatment Options in Allergy 2017; 4:383</ref> (e.g. intractable vomiting, ill-appearing, lethargic, hypotensive)
**[[Special:MyLanguage/Methylprednisolone|Methylprednisolone]] 1mg/kg IV
**[[Special:MyLanguage/Epinephrine|Epinephrine]] 0.01 mg/kg IM if shock/hypotension refractory to IV fluids


==Disposition==

*Admit if requires IV rehydration, electrolyte abnormalities, or intractable symptoms


==See Also==


==External Links==


==References==

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[[Category:Pediatrics]]
[[Category:GI]]
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