Rice protein-induced enterocolitis syndrome

Background & aims Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergic reaction, usually to cowʹs milk or soy protein. The aim is to present a series of infants with enterocolitis syndrome developed after rice ingestion. To our knowledge, the issue has only once been described in patients from Europe. Methods Data on five patients were retrospectively analyzed. The patients presented with vomiting, diarrhea and dehydration; therefore, allergy was not considered as a diagnosis and the patients underwent broad diagnostic evaluation. Finally, an open food challenge was performed for suspicion of rice allergy. Results Detailed clinical and laboratory findings are presented. As all patients had symptoms which could have been indicative of a broad spectrum of diseases, a median of two hospitalizations was needed to establish the diagnosis. When the rice protein-induced enterocolitis syndrome is suspected all patients should undergo open food challenge test, as no other diagnostic procedure can confirm the diagnosis. Conclusion This report shows that even hypoallergenic foods such as rice may cause FPIES and should be considered in the differential diagnosis of profuse vomiting and prostration in infants introduced to some kind of rice protein.