Food protein induced enterocolitis syndrome in infancy

Food protein induced enetrocolitis syndrome is a non IgE-mediated food allergy that typically presents in infancy, with repetitive vomiting that begins approximately 1 to 4 hours after food ingestion often accompanied by lethargy and pallor and can be followed by diarrhea. Two months old male infant presented with severe vomiting and diarrhea few hours after introduction of milk formula. On examination subicteric, severe dehydrated, with abdominal distention, systolic heart murmur 2/6, and minor facial dysmorphia. Initial laboratory tests showed hyponatremia, metabolic acidosis, liver damage and direct hyperbilirubinemia. Infant was rehydrated, electrolyte and acid-base disturbances were corrected, ursodesoxycholic acid was introduced and extensive hydrolisate nutrition was started. Causes for cholestatis were excluded. Аfter stabilization, folow up formula was introduced with the appearance of the same clinical presentation as 6 months ago. One month later 2 hours after unintentional intake of milk with the recurrence of vomiting and diarrhea, which confirmed the suspicion of food protein induced enterocolitis syndrome. Development of tolerance in patients with cow’s milk-induced food protein induced enterocolitis syndrome occures by the age around 3 years. There is need for identification of noninvasive biomarkers, understanding the pathophysiology, and having uniform aproaches to diagonsis and management.