Food protein-induced enterocolitis and enteropathy — structured clinical encounter

Structured encounter testing the approach to an infant with a recurrent delayed, pallid vomiting collapse after a new food: recognising acute food protein-induced enterocolitis syndrome, applying the 2017 consensus diagnostic criteria, separating it from sepsis and IgE-mediated allergy, resuscitating the acute reaction, and planning the avoidance pathway with a substitute feed and a supervised oral food challenge.

structured clinical encounter3 min readVerification in progress

Prompt

A seven-month-old presents pale, lethargic and vomiting repetitively two hours after rice cereal, having had the identical pattern two weeks earlier. You are the paediatric registrar working through the recognition of food protein-induced enterocolitis syndrome, the exclusion of sepsis and IgE-mediated allergy, the resuscitation of the acute reaction, and the avoidance and oral-food-challenge plan.

Station brief (candidate)

You are the paediatric registrar in the emergency department. A seven-month-old is brought in pale, lethargic and vomiting repetitively. Two hours earlier the child ate rice cereal for the second time, and the identical pattern occurred two weeks ago after rice. The team is treating the child as a possible case of sepsis and has asked you to establish the diagnosis, to direct the resuscitation, and to plan the longer-term pathway. You have 12 minutes with the team and 5 minutes for examiner discussion. [1]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Nowak-Węgrzyn A; Chehade M; Groetch ME; Spergel JM; Wood RA; Allen K International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol, 2017.PMID 28167094
[2]Sicherer SH; Eigenmann PA; Sampson HA Clinical features of food protein-induced enterocolitis syndrome. J Pediatr, 1998.PMID 9709708
[6]Leonard SA; Pecora V; Fiocchi AG; Nowak-Węgrzyn A Food protein-induced enterocolitis syndrome: a review of the new guidelines. World Allergy Organ J, 2018.PMID 29441147
[8]Feuille E; Nowak-Węgrzyn A Medical Algorithms: Recognizing and treating food protein-induced enterocolitis syndrome. Allergy, 2019.PMID 31070799
[11]Feuille E; Menon NR; Huang F; Nowak-Węgrzyn A Knowledge of food protein-induced enterocolitis syndrome among general pediatricians. Ann Allergy Asthma Immunol, 2017.PMID 28890023