Clinical Nutrition (2006) 25, 533–536 SHORT REPORT Rice protein-induced enterocolitis syndrome Iva Hojsak a,Ã , Mirjana Kljaic ´-Turkalj b , Zrinjka Mis ˇak a , Sanja Kolac ˇek a a Referral Center for Pediatric Gastroenterology and Nutrition, Zagreb Children’s Hospital, Klaic ´eva 16, HR-10000 Zagreb, Croatia b Special Hospital for Children and Adolescents, Srebrnjak 100, Zagreb, Croatia Received 26 October 2005; accepted 8 December 2005 KEYWORDS Food protein-in- duced enterocolitis syndrome; Rice; Allergy Summary Background & aims: Food protein-induced enterocolitis syndrome (FPIES) is a non- IgE-mediated allergic reaction, usually to cow’s 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. & 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. Introduction In general, food allergy is a spectrum of disorders that result from an aberrant immune response to dietary antigens, which can be either IgE-mediated or non-IgE-mediated. In IgE-mediated food allergy, T-cell-directed antigen-specific IgE production leads to sensitization, and re-exposure to the same antigen results in the release of mediators causing allergic reaction. The second, non-IgE-mediated mechanism results from direct T cell antigen response, mediated by proinflammatory cytokines ARTICLE IN PRESS http://intl.elsevierhealth.com/journals/clnu 0261-5614/$ - see front matter & 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2005.12.005 Ã Corresponding author. Tel.: +38598623885; fax: +38514600160. E-mail address: ivahojsak@gmail.com (I. Hojsak).