Food protein-induced enterocolitis syndrome (FPIES) is a none-IgE-mediated food hypersensitivity reaction that manifests mainly with gastrointestinal symptoms. Two distinct phenotypes of FPIES are recognized: Acute FPIES is characterized by profuse repetitive vomiting accompanied by pallor and lethargy occurring 1 to 4 hours after food ingestion. Chronic FPIES occurs in infants when the offending food is ingested as part of the diet on a regular basis presenting as intermittent emesis, chronic diarrhea, poor weight gain, or failure to thrive.
FPIES occurs most often early in life; usually, milk- and soy induced FPIES present before 6 months of life, whereas FPIES caused by other solid foods occurs later (6-12 months). The most common reported triggers of FPIES are cow’s milk, soy, and various grains such as rice, oat, barley, and wheat. However, a wide range of foods are associated with this syndrome, including white and sweet potatoes, eggs, chicken, vegetables, fruits, shellfish, fish, nuts, and peanuts. However, sesame has not been reported yet.
We report the first 5 cases of FPIES induced by sesame seed. The patients were evaluated at the allergy departments of 3 different medical centers in Israel within the last 2 years.
In conclusion, acute FPIES to sesame has not been previously reported. It may well have been overlooked and interpreted as a viral illness or food poisoning, and as such, affected children are at risk for repeated severe reactions. Therefore, we believe that primary care physicians, pediatricians, and allergists should be familiar with this unique entity.
