A piece of FPIES – a non-IgE mediated allergy emergency

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed gastrointestinal symptoms, often misdiagnosed due to its overlap with infectious and other allergic conditions. In this case symptoms occurred within one hour of exposure on two separate occasions and resolved within twenty-four hours with supportive care. Skin prick testing with both commercial egg extract and fresh egg yielded negative results, effectively excluding IgE-mediated mechanisms. Based on clinical history, timing of the symptoms, recurrence on re-exposure and resolution with dietary exclusion, a diagnosis of acute FPIES to egg was made. The patient was managed on strict egg exclusion, provision of an emergency action plan and counseling regarding the natural history of the condition and the likelihood of outgrowing it, with future oral food challenge planned to assess tolerance. This case highlights the importance of recognizing FPIES as a distinct form of food allergy, especially in the Caribbean where awareness is low and epidemiological data is lacking. Early diagnosis and guideline based management is crucial to avoid misdiagnosis as sepsis or gastroenteritis, ensure parents education and prevent unnecessary interventions.