European Journal of Pediatrics

, Volume 173, Issue 12, pp 1545–1547 | Cite as

Food protein-induced enterocolitis syndrome to trivial oral mucosal contact

  • Shikha K. Mane
  • Margaret E. Hollister
  • Sami L. Bahna
Case Report


Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated gastrointestinal food hypersensitivity, mostly in infants. Patients usually present very ill and often misdiagnosed as acute gastroenteritis, sepsis, ileus, metabolic disorders, necrotizing enterocolitis, or severe gastroesophageal reflux disease. We present a case of an infant who had three acute FPIES episodes: the first was at 5 months of age after chewing on a cellophane wrapper, the second was due to sweet potato, and the third was due to rice cereal. It was realized that in the first episode, the wrapper was covering a rice cake. Evaluation at 7 months of age, while asymptomatic, showed normal complete blood count, low serum immunoglobulin E level, and negative allergy skin prick tests, indicating non-IgE sensitivity. Conclusion This case of FPIES has peculiar features in that it occurred in an exclusively breastfed infant and by non-ingestant oral contact with a trivial quantity of rice allergen.


Food protein-induced enterocolitis syndrome FPIES Enterocolitis Food allergy Rice allergy Sweet potato allergy 


Conflict of Interest

We declare that there are no conflicts of interest.


  1. 1.
    Caubet JC, Nowak-Wegrzyn A (2011) Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome. Expert Rev Clin Immunol 7:317–327PubMedCrossRefGoogle Scholar
  2. 2.
    Chapman J, Bernstein L, Lee R, Oppenheimer J, Nicklas R, Portnoy J et al (2006) Food allergy: a practice parameter. Ann Allergy Asthma Immunol 96:S1–S68CrossRefGoogle Scholar
  3. 3.
    Coates R, Weaver K, Lloyd R, Ceccacci N, Greenberg M (2011) Food protein-induced enterocolitis syndrome as a cause for infant hypotension. West J Emerg Med 12:512–514PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Fernandes BN, Boyle RJ, Gore C, Simpson A, Custovic A (2012) Food protein-induced enterocolitis syndrome can occur in adults. J Allergy Clin Immunol 130:1199–1200PubMedCrossRefGoogle Scholar
  5. 5.
    Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M (2011) The prevalence and natural course of food protein-induced enterocolitis syndrome to cow’s milk: a large-scale, prospective population-based study. J Allergy Clin Immunol 127:647–653PubMedCrossRefGoogle Scholar
  6. 6.
    Leonard SA, Nowak-Wegrzyn A (2012) Clinical diagnosis and management of food protein induced enterocolitis syndrome. Curr Opin Pediatr 24:739–745PubMedCrossRefGoogle Scholar
  7. 7.
    Leonard SA, Nowak-Wegrzyn A (2011) Food protein-induced enterocolitis syndrome: an update on natural history and review of management. Ann Allergy Asthma Immunol 107:95–101PubMedCrossRefGoogle Scholar
  8. 8.
    Mehr S, Kakakios A, Frith K, Kemp AS (2009) Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics 123:459–464CrossRefGoogle Scholar
  9. 9.
    Monti G, Castagno E, Liguori SA (2011) Food protein-induced enterocolitis syndrome by cow’s milk proteins passed through breast milk. J Allergy Clin Immunol 127:679–680PubMedCrossRefGoogle Scholar
  10. 10.
    Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH (2003) Food protein induced enterocolitis syndrome caused by solid food proteins. Pediatrics 111:829–835PubMedCrossRefGoogle Scholar
  11. 11.
    Omata N, Ohshima Y, Yamada A, Yasutomi M, Tokuriki S, Mayumi M (2008) A case of milk-protein-induced enterocolitis associated with enterotoxigenic E. coli and MRSA infections. Eur J Pediatr 167:683–684PubMedCrossRefGoogle Scholar
  12. 12.
    Sampson HA, Anderson JA (2000) Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr 30:S87–S94PubMedCrossRefGoogle Scholar
  13. 13.
    Tan J, Campbell D, Mehr S (2011) Food protein-induced enterocolitis syndrome in an exclusively breast-fed infant—an uncommon entity. J Allergy Clin Immunol 129:873CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Shikha K. Mane
    • 1
  • Margaret E. Hollister
    • 1
  • Sami L. Bahna
    • 1
  1. 1.Allergy and Immunology Section, Department of PediatricsLouisiana State University Health Sciences CenterShreveportUSA

Personalised recommendations