Delayed presentation of food protein-induced enterocolitis syndrome (FPIES) to okra in a toddler

Hunter Hall; Sara Anvari; Fallon Schultz; Olubukola Ojuola; Nicholas L Rider

doi:10.1186/s13223-024-00871-1

Delayed presentation of food protein-induced enterocolitis syndrome (FPIES) to okra in a toddler

Allergy Asthma Clin Immunol. 2024 Feb 3;20(1):9. doi: 10.1186/s13223-024-00871-1.

Authors

Hunter Hall¹, Sara Anvari², Fallon Schultz³, Olubukola Ojuola⁴, Nicholas L Rider⁵

Affiliations

¹ Department of Biology, Liberty University, Lynchburg, VA, USA.
² Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
³ International FPIES Association, Point Pleasant Beach, NJ, USA.
⁴ Division of Pediatrics, Liberty University College of Osteopathic Medicine, Collaborative Health Partners, Lynchburg, VA, USA.
⁵ Department of Health System & Implementation Science, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 249, Roanoke, Virginia, 24016, USA. nick70@vt.edu.

Abstract

Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE) -mediated food allergy predominantly observed in infants and characterized by the delayed onset of vomiting following ingestion of a trigger food. An increase in research and clinical consideration of FPIES has led to the discovery of unique deviations from the standard FPIES triggers and presentations.

Case presentation: A 34-month-old female patient with a history of consuming okra daily presented to medical attention after developing classic FPIES symptoms to okra beginning at 14-months of age.

Conclusions: Recently, awareness about the varied nature of FPIES clinical presentation has come to light. This case is the first to describe FPIES to the fruit okra that developed over a 12-month time span after previously tolerating the food. This case serves to emphasize the importance of understanding the range of FPIES symptoms to improve recognition and expedite best practice recommendations.

Keywords: Food allergy; Food protein-induced enterocolitis syndrome (FPIES); Non-immunoglobulin E (IgE); Okra; Vomiting.