Table 2.
Differential diagnosis of FPIES [1]
| Condition | Features that may distinguish from FPIES |
|---|---|
| Infectious gastroenteritis (e.g. viral, bacterial) | Single episode of illness, fever, sick contacts |
| Sepsis | Fluid resuscitation alone not effective |
| Necrotizing enterocolitis (NEC) | Newborns and younger infants, rapid escalation of symptoms, bloody stools, shock, intramural gas on abdominal radiographs |
| Anaphylaxis | Symptoms begin within minutes to 2 h of exposure, positive IgE testing, usually other manifestations (e.g. urticaria) |
| Food aversion | Look at the familial context |
| Inborn errors of metabolism: Urea cycle defects, Hereditary fructose intolerance, hyperammoiniemic syndromes, propionic /methylmalonic aciduria, beta-oxydations defects, hyperinsulinism-hyperammonemia syndrome, Pyruvate dehydrogenase deficiency, mitochondrial disorders, maple syrup urine disease, ketothiolase deficiency. | Developmental delay, neurologic manifestations, organomegaly, reaction to fruits |
| Lactose intolerance | In severe form, gas, bloating, cramps, diarrhea, borborygmi and vomiting following ingestion of liquid milk and large doses of dairy products with lactose |
| Neurologic disorders (e.g. cyclic vomiting) | No relation to specific food intake |
| Gastrointestinal reflux disease | Emesis more chronic and not usually severe (i.e. does not lead to dehydration), only upper GI symptoms present |
| Hirschsprung’s disease | Delay in passage of the first meconium, marked abdominal distention |
| Food protein-induced enteropathy | Symptoms usually not temporarily associated with specific food intake, symptoms more chronic than episodic, vomiting less severe, most commonly implicated foods cow milk, soy, wheat, egg white |
| Eosinophilic gastroenteropathies (e.g. eosinophilic esophagitis, eosinophilic gastroenteritis) |
Usually not associated with specific food intake, symptoms more chronic than episodic, vomiting less severe, more likely to have positive IgE tests |
| Celiac disease | No temporal relationship between symptoms and specific food intake; progressive malabsorption; celiac serology is positive |
| Immune enteropathies (e.g. inflammatory bowel disease, autoimmune enteropathy, immunodeficiency) | Rare in infancy, not related to specific food intake |
| Obstructive problems (e.g. malrotation, Ladd’s bands, volvulus) | Not related to specific food intake, evidence of obstruction on radiological studies |
| Coagulation defects | No relation to specific food intake |
| Alpha1-antitrypsine deficiency | No relation to specific food intake; hepatic involvement |
| Primary immunodeficiencies | No relation to specific food intake; intestinal symptoms, frequent infections. |