Enterocolitis inducida por proteínas de pescado

Abstract

Food Protein-Induced Enterocolitis Syndrome (FPIES) is an uncommon non-IgE-mediated gastrointestinal food hypersensitivity that typically appears in the first year of life. FPIES symptoms consist on recurrent delayed vomiting, diarrhea, lethargy, pallor, hypotension, and may progress to a state of dehydration and hypovolemic shock. It can resemble a septic shock and that should be the first differential diagnosis. The clinical features repeat every single time the child eats the culprit protein and is totally resolved once this food is removed from the diet. Although several reports have been published in the past few years, there is still a lack of knowledge about this syndrome, its epidemiology, and its clinical characteristics. The most frequent offending foods are cow´s milk and soy. Among the solid foods, rice is one of the most causative foods, but it varies depending on the geographic area. Recent researches show that fish is one of the most important triggers of FPIES in the Mediterranean countries, mainly Spain or Italy. The prognosis of FPIES depends on the causative food and in the case of FPIES due to fish, it does not seem so favourable and the disease is not always outgrowth. The only treatment available is the avoidance of the offending food responsible for the symptoms. That means that children with FPIES by fish should have a completely free-fish-diet until they outgrown the disease. There is not a specific biological marker for the disease that allows us to confirm or to predict when tolerance to the offending food has been achieved. This is the reason why patients with FPIES should undergo an oral food challenge (OFC) at least once. The OFC is not lack of risk and many patients develop moderated and severe symptoms after this procedure