Food Hypersensitivity (Non–IgE-Mediated, Gastrointestinal)
- A non–IgE-mediated reaction to a food protein that involves the gastrointestinal (GI) tract
- Previously referred to as milk protein intolerance
- Includes the following:
- Food protein–induced proctocolitis
- Food protein–induced enteropathy
- Food protein–induced enterocolitis syndrome (FPIES)
- Proctocolitis: >60% of infants with rectal bleeding have proctocolitis.
- Enteropathy: may occur after infectious gastritis
- Slight male predominance (60%)
- 30% of infants with FPIES have atopic disease(s).
- Family history of atopy present in 40–80%
- 40% react to both milk and soy.
- 50–60% of infants are breastfed and react to milk and/or soy in mom’s diet.
- Enteropathy: usually formula-fed and given intact cow’s milk prior to 9 months of age
- FPIES: Exclusive breastfeeding appears to protect against FPIES, but a few cases have been reported.
- Currently, no reports that non–IgE-mediated GI food hypersensitivities are inherited.
- Assumed to be a cell-mediated reaction due to delayed onset
- Cow’s milk is the most common cause of proctocolitis, enteropathy, and FPIES, followed by soy, egg, and wheat.
- FPIES: can also react to solid foods thought to be hypoallergenic (rice, oat, barley, chicken, turkey, peanut, potato, corn, fruit protein, fish, and mollusks)
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