Fruit-induced FPIES masquerading as hereditary fructose intolerance

Alessandro Fiocchi, Carlo Dionisi-Vici, Giovanna Cotugno, Pierluigi Koch, Lamia Dahdah

Research output: Contribution to journalArticlepeer-review

Abstract

Hereditary fructose intolerance (HFI) symptoms develop at first introduction of fruit during weaning. We report on an infant with suspected HFI who presented with repeated episodes of vomiting and hypotension after ingestion of fruit-containing meals. The first episode occurred at age 4 months. Despite negative genetic testing for HFI, strict avoidance of fruit ingestion resulted in lack of recurrence of symptoms. Oral-fructose-tolerance testing conducted with an apple mousse did not determine hypoglycemia or fructosuria but caused severe hypotension. Allergy evaluations were negative, and the history was diagnostic for fruit-induced food protein-induced enterocolitis syndrome. Because this non-immunoglobulin E-mediated gastrointestinal food hypersensitivity manifests as profuse, repetitive vomiting, often with diarrhea, leading to acute dehydration and lethargy, it may be misinterpreted as HFI. We advise pediatricians to consider food protein-induced enterocolitis syndrome in the differential diagnosis when there is a suspicion of HFI.

Original languageEnglish
JournalPediatrics
Volume134
Issue number2
DOIs
Publication statusPublished - Aug 1 2014

Keywords

  • Food hypersensitivity
  • Food protein-induced enterocolitis syndrome
  • Hereditary fructose intolerance
  • Hypersensitivity
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

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