Acronym for Food Protein Induced Enterocolitis SyndromeRare. Affects especially  infants. Particular form of food allergy (non-IgE-mediated food hypersensitivity) the signs of which are mainly digestive. Its pathophysiology is complex: it is probably caused by local inflammation  mediated by T cells; however specific IgE for food are found in about 25% of patients

Acute form: projective vomiting with hypotonia and lethargy starting 1 to 3 hours after ingestion of the causal food; sometimes viscous or bloody diarrhea 6 to 12 hours later. Severe forms can lead to hypovolemic shock.

Insidious form: agitation, gastroesophageal reflux, loose stools; finally, growth retardation. The diagnosis is often delayed.

Foods most often involved: milk (median of 1st reaction time: 20 days) soy protein, rice; more rarely: fish, chicken, oats. The signs appear between 1 and 4 weeks after the introduction of the food.

Treatment: food exclusion during at least 1 year with attempts to reintroduce the causal food.

Diagnosis: test of exclusion-reintroduction of the suspect food (milk, soy)

With regard to milk and soy, hypersensitivity disappears spontaneously between the age of 3 and 5 years.

Anesthetic implications:

patients should be considered as atopic and at higher risk of allergic type reaction to anesthetic agents ; hypovolemia if recent vomiting and diarrhea; anemia, hypoproteinemia; growth retardation. Care should be taken to carefully wash   hands after eating in order to minimize allergen exposure to the patient.

References : 

-        Leonard SA, Nowak-Wegrzyn A. 
Food protein-induced enterocolitis syndrome : an update on natural history and review of management. 
Ann Allergy Asthma Immunol 2011; 107: 95-101.

-        Delahaye C, Chauveau A, Kiefer S, Dumond P.
Syndrome d’entérocolite induite par les protéines alimentaires (SEIPA) : une série de 14 enfants.
Arch Pédiatr 2017 ; 24 : 310-6.

-        Fernandez PG, Mickhael M.
Perioperative considerations for the food-allergic pediatric patient.
Pediatr Anesth 2017; 27: 461-70

Updated: April 2017