Immunologic reactions to foods involving mechanisms other than immediate hypersensitivity, such as cell-mediated immunity (see Table 57-2), play a role in food protein-induced enterocolitis syndromes (FPIES), such as cow's milk protein enteropathy, and also celiac disease. FPIES also known as food protein-induced enteropathies, present in infancy or early childhood and are most commonly due to cow's milk protein followed by soy protein and less commonly, egg, fish, and other food antigens (Nowak-Wegrzyn et al, 2003). Clinical manifestations include diarrhea, vomiting, anemia, bleeding, and failure to thrive. As with many other food allergies, such cases are managed by elimination of the specific food antigen until the disease resolves with age. It is common practice to switch infants with enterocolitis from a cow's milk-based formula to a soy-protein derived formula, but because over half will react to soy protein, continued problems may result from the development of soy-protein-induced enterocolitis. Hypoallergenic or elemental feeds are often necessary in such cases.
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