Two cases of food protein-induced enterocolitis syndrome by fish

Abstract

Non-IgE-mediated food protein-induced gastroenteropathy that exhibits relatively acute symptoms is classified as food protein-induced enterocolitis syndrome. The cause of most cases is infant formula, as solid food is rarely a causative antigen. However, there have been several reports of cases resulting from fish consumption in Japan. Case 1 was a seven-year-old male who repeatedly experienced vomiting after eating swordfish since the age of two. The specific IgE antibody against each fish was negative, the lymphocyte stimulation test for swordfish was positive, and the oral food challenge test for swordfish was positive. Case 2 was a two-year-old female who repeatedly experienced vomiting after salmon, flounder, and sawara (Spanish mackerel) consumption during the weaning period. The specific IgE antibody against each fish was negative, and the lymphocyte stimulation tests for tuna, flounder, sawara, and salmon were all positive. Both cases showed reproducible symptoms, and the patients were diagnosed based on their history. The results of the oral food challenge tests and lymphocyte stimulation tests were also used to help in diagnosis. Reports of solid food cases, especially with fish as a causative antigen, are rare, and the non-specific symptoms are likely to cause a delay in diagnosis. Prompt diagnosis is essential as symptoms may become chronic depending on the disease type. Therefore, it should be recognized that solid foods can be causative antigens, and that non-IgE-mediated food protein-induced gastroenteropathy should be considered for the differential diagnosis of repetitive digestive symptoms.