Table 4.

What is known and what is unknown in FPIES

What is known`

What is unknown

FPIES typically occurs in infants and children; age of onset depends on theintroduction of food into the dietFPIES mostly occur in non-breast-fed infants; FPIES whilst an infant is breastfed is rareRepetitive vomiting is the most prominent symptomFPIES can be classified according to onset (early versus late), severity (mild-to-moderate vs severe), and timing (acute versus chronic)There is no single diagnostic test specific for FPIES, thus diagnosis is aclinical oneOFC should be considered in the initial diagnostic evaluation for cases in which the history is unclear or atypical, a single episode is reported, a food trigger is not identified, if symptoms persist despite removing the suspected trigger food from the diet or in cases of chronic FPIES symptoms being these less specificWhen breastfeeding is not possible, or if there is no improvement of symptoms whist a maternal elimination diet an extensively hydrolysed formula is recommendedIn case of FPIES with growth faltering or failure of eHF an elemental formula is recommended

Underlying immunologic mechanisms Natural historyPotential consequences over timeStarting Doses of oral food challengeInterval between doses during oral food challengeTolerance to cooked/baked productTolerance to small amount of trigger foodTiming of solid foods introductionType of first solid food introduction