Journal Article

Food protein–induced enterocolitis syndrome after involuntary gluten transgression in celiac children: A new increasingly common complication?

García Barrionuevo, Claudia, Muñoz-Cruzado Rosete, Adrián, Lozano Sánchez, Gema, Trillo Belizón, Carlos, Ramón Salguero, Jose Manuel, Ramos Rodríguez, Alicia

2025

Overview

•Food protein–induced enterocolitis syndrome (FPIES) is a cell-mediated food allergy without involvement of IgE antibodies.•The relevance of the reported cases resides in alerting health care professionals working at pediatric emergency services of the possibility of encountering FPIES-type reactions in celiac children in order to optimize their treatment and avoid unnecessary therapies.•We propose that the appearance of FPIES-type reactions to wheat in celiac patients might be related to a long-term gluten-free diet. Among the possible adverse reactions to gluten, celiac disease, non-celiac gluten sensitivity, and IgE-mediated wheat allergy have been classically described. A non–IgE-mediated reaction similar to food protein–induced enterocolitis syndrome (FPIES) after inadvertent gluten ingestion in a celiac patient was recently reported. We present three children affected by celiac disease with exquisite control, including appropriate adherence to an exclusion diet, who suffered a severe adverse food reaction after unappreciated outdoor ingestion of gluten, meeting the criteria for a definitive diagnosis of FPIES. The strict and prolonged exclusion of gluten from the diet is postulated as the possible trigger for this serious entity after an involuntary transgression. Although the first published cases are recent, we might be witnessing an increase in the frequency of presentation. Therefore, we believe emergency services must be alert to the possibility of diagnosis of FPIES in celiac patients due to involuntary transgressions. The determination of gluten glycoimmunopeptides in urine or stool samples may be useful for certifying the inadvertent consumption of wheat as the cause of FPIES.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Allergies / Antibodies / Autoimmune diseases / Blood pressure / Celiac disease / Celiac Disease - complications / Celiac Disease - diet therapy / Child / Diagnosis / Diarrhea / Diet / Diet, Gluten-Free - adverse effects / Dietary Proteins - adverse effects / Disease control / Emergency medical care / Emergency services / Enterocolitis / Enterocolitis - diagnosis / Enterocolitis - etiology / Exclusion diet / Food / Food allergies / Food Hypersensitivity / FPIES / Gastroenterology / Gluten / Glutens - adverse effects / Hepatology / Humans / Hypotension / Hypothermia / Immunoglobulin E / Ingestion / Intubation / Nutrition / patients / Pediatrics / Proteins / Syndrome / Triticum - adverse effects / urine / Vomiting / Wheat / wheat allergy