An exploration of factors associated with food protein‐induced enterocolitis syndrome: Birth, infant feeding and food triggers

Lee, Eric; Barnes, Elizabeth H; Mehr, Sam; Campbell, Dianne E.

doi:10.1111/pai.13448

Cited by 20 publications

(24 citation statements)

References 22 publications

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“…[7][8][9][10][11][12] The most frequent culprit food was fish in Greece 13 and Spain 10,14 rice in Australia [15][16][17] and the USA, 18 and oats in Taiwan. 19 Soy is frequently reported as a trigger food by North American, British, Australian and Israeli cohorts 4,17,20,21 and was infrequent in our population. Food habits, geographic origins, genetic factors, microbiota, and other environmental pre-or postnatal factors may explain these differences.…”

Section: Discussionmentioning

confidence: 99%

“…The age at resolution was based on the day of performance of an OFC and thus may be overestimated. Previous studies suggested that the later age of tolerance relates to the ingestion of seafood products 6,9,17,22 and may occur more frequently in cases of multiple FPIES. 6 Resolution of FPIES to fish is around 18.8% to 57.0% of cases between 3 to 4.5 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…28 We reported a lower frequency of multiple FPIES (5.6%) than in the literature which is commonly reported at around 30%. 2,17,20,21 This may result from the use of stringent criteria for the diagnosis of FPIES and the retrospective design of the study. Despite medical charts studied, for multiple FPIES in 13.4% of cases as per other series, 7,10,14,15 we only retained FPIES with a specific clinical description.…”

Section: Discussionmentioning

confidence: 99%

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Food protein-induced enterocolitis syndrome: a large French multicentric experience

Lemoine¹,

Colas²,

et al. 2021

Preprint

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Background Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated food allergy, with potential dehydration secondary to vomiting. Differences exist regarding culprit foods, onset symptoms, and age of tolerance depending on the country of origin. We aimed to describe the characteristics of a French population of children with FPIES. Methods Data from 179 children who were referred for acute or chronic FPIES in two pediatric tertiary centers between 2014 and 2020 were retrospectively collected. The diagnosis of FPIES was based on international consensus guidelines. Clinical characteristics, culprit food and age at resolution were assessed. Results In the 192 described FPIES, the age at first symptoms was 5.8 months old. The main offending foods were cow’s milk (60.3%), hen’s egg (16.2%), and fish (11.7%). Single FPIES was observed in 94.4% and multiple FPIES in 5.6% of cases. The age at resolution of FPIES was 2.2 years old, and resolution occurred later for fish than for milk (2.9 years versus 2.0, p=0.01). Severe acute FPIES was a risk factor for delayed resolution (relative risk: 3.3 [1.2-9.2]), but not IgE sensitization. Performing an oral food challenge within 12 months after the first reaction increased the risk of failure (RR: 2.0 [1.2-3.5]). Conclusion In this French cohort of children with FPIES, the main culprit foods were ubiquitous. Rice, oat and soy were rarely or not involved. Multiple FPIES was infrequent. Our data confirmed the overall good prognosis of FPIES, the later resolution of FPIES to fish and in the case of severe acute FPIES.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Food protein-induced enterocolitis syndrome: a large French multicentric experience

Lemoine¹,

Colas²,

et al. 2021

Preprint

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“…7 A recent cohort study from Australia over the last decade also found a 4-month delay among their patients. 8 In addition to a prolonged length to diagnosis, patients may also experience a number of FPIES episodes prior to diagnosis. Blackman et al found that 32% of patients had up to four FPIES episodes prior to diagnosis and Mehr et al who found that 20% of patients had up to four episodes prior to diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Food Protein-Induced Enterocolitis Syndrome: Healthcare Utilization and Referral Patterns Among a Pediatric Cohort

Pier

Bingemann

Badwal

et al. 2022

Preprint

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BACKGROUND: Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed, repetitive vomiting. FPIES has gained attention over the last few years and is becoming better recognized; however, there remains a lag in diagnosis. This study aimed to further explore this lag in diagnosis, as well as referral patterns and healthcare utilization, to determine areas for earlier recognition. METHODS: Data was obtained through retrospective chart reviews of pediatric FPIES patients at two hospital systems in New York. Charts were reviewed for age of symptom onset, age of diagnosis, FPIES episodes and healthcare visits prior to diagnosis, and reason/source of referral to allergy. A cohort of patients with IgE-mediated food allergy was reviewed for comparison. RESULTS: In total, 110 patients with FPIES were identified. The median length to diagnosis was 3 months, compared to 2 months in IgE-mediated food allergy (p < 0.05). Most referrals were from the pediatrician (68%) or gastroenterology (28%), none were from the ED. The most common reason for referral was concern of IgE-mediated allergy (51%), followed by FPIES (35%). CONCLUSION: This study demonstrates a lag in the diagnosis of FPIES and a lack of recognition of FPIES outside of the allergy community, as only one-third of the patients were considered to have FPIES prior to an allergy evaluation. Patients with profuse, repetitive vomiting 1- 4 hours after food ingestion, especially of common FPIES trigger foods, should be considered for diagnosis of FPIES, as these encounters provide an opportunity for early recognition.

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“…The present study enrolled 21 patients with EY-FPIES (1) diagnosed by positive oral food challenge (OFC) tests at our hospital between April 2018 and April 2021 who (2) subsequently underwent OFC to evaluate tolerance acquisition (re-OFC) at least once. The open OFC was performed by ingestion of a single dose once or three divided doses every 30 minutes.…”

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confidence: 99%

Early diagnosis and intervention induce early tolerance in egg yolk-associated FPIES.

Okura

Shimomura

Takahashi

et al. 2022

Preprint

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To the Editor, Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE) mediated food allergy that predominantly affects infants and is characterized by repetitive vomiting that occurs 1-4 h after the ingestion of causative food. The etiology and underlying mechanisms of FPIES are not well understood. Recently, egg yolk (EY) has been recognized as a major causative food of FPIES. 1,2 Most FPIES patients achieve tolerance with age; 3 however, the practice management of EY-associated FPIES (EY-FPIES) has yet to be established. In a preliminary analysis of EY-FPIES, we found that the patients who acquired tolerance to EY had been diagnosed at a significantly younger age than non-tolerated patients despite no difference in the age of onset between both patients. This suggested that the early diagnosis and intervention is beneficial for tolerance acquisition in EY-FPIES. To investigate this further, we compared clinical outcomes between the early and late diagnosis of EY-FPIES.

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An exploration of factors associated with food protein‐induced enterocolitis syndrome: Birth, infant feeding and food triggers

Cited by 20 publications

References 22 publications

Food protein-induced enterocolitis syndrome: a large French multicentric experience

Food protein-induced enterocolitis syndrome: a large French multicentric experience

Food Protein-Induced Enterocolitis Syndrome: Healthcare Utilization and Referral Patterns Among a Pediatric Cohort

Early diagnosis and intervention induce early tolerance in egg yolk-associated FPIES.

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