Abstract

Introduction. Food protein-induced enterocolitis (FPIES) is a non-immunoglobulin E (IgE)-mediated food allergy syndrome typically diagnosed in infancy and childhood presenting with delayed onset of repeated vomiting. The most common allergens causing FPIES reactions are cow’s milk, soy, cereals, and rice. However, honey, propolis and royal-jelly can also trigger allergic reactions. Cases of food allergy related to honey described in the literature are very rare. Honey is mainly composed of water, sugars such as fructose and glucose, a very small quantity of proteins  drived from the pharyngeal and salivary glands of bees (Apis Mellifera), and spores, algae, vitamins, minerals, etc.

Materials and methods. We describe a case of a 4-year-old boy who had recurrent episodes of repetitive emesis, each lasting at least 2 hours after consuming honey or royal-jelly or any food containing honey. No evidence of IgE-mediated sensitization was documented, either by skin prick tests or by the assay of specific IgE for honey, pollen and bee venom.

Results. We performed an oral food challenge (OFC) with acacia honey: two hours after ingestion our patient presented repetitive emesis and two more episodes of vomiting occurred in the following two hours.

Discussion and Conclusions. This case shows the importance of considering isolated vomiting as a possible symptom of honey allergy, even in the absence of positive standard diagnostic tests. We hypothesized that it could be a FPIES triggered by honey, given the isolated repetitive gastrointestinal manifestation, the absence of any symptoms of IgE-mediated food allergy and the negativity of IgE test. Further tests (blood count, tryptase dosage and calprotectin) during the next OFC may be useful for diagnosis. Clinical management involves a correct diagnostic process, an avoidance diet and patient education

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Authors

Fabrizio Leone - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

Martina Vetrò - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

Ottavia De Angelis - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

Serena Marangio - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

Gabriella Cusa - Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy

Matteo D'Ambrosi - Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy

Sonia Iavarone - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

Anna Maria Zicari - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

Caterina Anania - Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy

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Copyright (c) 2025 Italian Journal of Pediatric Allergy and Immunology

How to Cite
Leone, F., Vetrò, M., De Angelis, O., Marangio, S., Cusa, G., D’Ambrosi, M., Iavarone, S., Zicari, A. M., & Anania, C. (2025). Honey-Induced FPIES: A Rare Presentation and Pathogenetic Insights. Italian Journal of Pediatric Allergy and Immunology, 39(1). https://doi.org/10.53151/2531-3916/2025-1010
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