D3.70 - Multiple Food Protein-Induced Enteropathy Syndrome: The Role of Skin Patch Testing in Guiding Effective Decision-Making
Case report
Introduction
Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated gastrointestinal hypersensitivity characterized by recurrent vomiting, profuse diarrhea, and potential progression to dehydration, multiorgan failure, and even fatality. It primarily affects infants, being the common triggers cow and soy milk, and solid foods. We present a case of FPIES triggered by multiple food proteins, where skin patch testing (SPT) was used to identify potential allergens and guide safe food reintroduction during hospitalization.
Case Report
A 4-year-old boy with Down syndrome and a history of severe cow´s milk protein allergy (FPIES) since infancy was fed an amino acid-based formula. By 6 months, he developed FPIES to pumpkin, potatoes, and tangerines, resulting in hypovolemic shock requiring ICU on three occasions. At the hospital, through controlled oral food challenges, we (multidisciplinary team) successfully reintroduced egg, wheat, corn, chicken, and rice. Due to dietary restrictions and their impact on his growth, a plan was made to reintroduce multiple foods simultaneously (at least 3 per challenge) under close medical supervision.
Methods
First, we carefully selected foods to avoid rejection by using SPTs, taking into account FPIES cellular hypersensitivity mechanisms. We used prick test as well, to prevent an IgE mechanism. By doing so we identified safe foods for reintroduction.
Results
SPT readings at 24 and 48 hours identified positive reactions to potatoes, broccoli, beef, bananas, and tomatoes. Negative results for apples, lentils, and carrots allowed their successful reintroduction. Prick tests were also negative.
Discussion
While SPT's diagnostic accuracy remains controversial due to variability in sensitivity and specificity, it proved valuable in this case for predicting food reactions and guiding safe reintroduction in FPIES, a condition driven by cellular hypersensitivity mechanisms.
Conclusion
Despite gaps in understanding FPIES pathophysiology, SPT emerged as a useful tool for identifying safe foods and reducing risks during reintroduction. This case highlights the need for further research into the immunological mechanisms underlying FPIES.
