Epidemiology of food protein-induced enterocolitis syndrome

Abstract

Purpose of reviewTo summarize the epidemiology of food protein-induced enterocolitis syndrome (FPIES).Recent findingsFPIES is regarded as a rare non-IgE-mediated gastrointestinal allergic disorder. Older nonpopulation-based studies reported an average of 1–15 cases presenting to allergy clinics a year, but recent studies have reported figures as high as 90 cases a year. The yearly incidence of FPIES in one Australian study was one in 10,000 infants less than 2 years of age. Chronic FPIES typically presents in neonates, whereas acute FPIES is primarily a disorder of young infants. FPIES has a slight male predominance; eczema and a family history of atopy are commonly present at diagnosis; almost one in 10 infants have coexistent IgE food allergies and siblings are rarely affected. There is regional variation in common triggering foods, rates of combined cow milk and soy FPIES and multiple food group FPIES. Understanding of the epidemiology of FPIES is limited by the lack of a universally accepted definition and the publication of few prospective population-based case series.SummaryFPIES is not as rare as once thought, but how common it is, what factors predispose to its development, and why there is regional variation needs to be addressed by future well designed population-based studies?

Food Protein-Induced Enterocolitis Syndrome, Allergic Proctocolitis, and Enteropathy

“…However, this may be an underestimate as reporting is voluntary and accurate reporting could be hampered by incomplete understanding of FPIES among general practitioners [11]. There is some suggestion that prevalence may be increasing, though it is unclear whether this is related to improved recognition or a true increase in prevalence [12][13][14].…”

Introducing Allergenic Foods in Infants

“…No cohort study has systematically recorded the prevalence of FPIES with regard to multiple foods, and hence the true prevalence of FPIES is unknown. 1 We state in the Supplementary Appendix of our article that the cases we observed were FPIES-like, because we did not undertake confirmatory challenges immediately for FPIES-like reactions (on safety grounds), hence the true rate of FPIES in our trial may have been somewhat lower.…”

“…The foodprotein-induced enterocolitis syndrome (FPIES) during the first 5 months of life occurred in 7 participants in the early-introduction group (with cooked egg in 6 participants) but in only 3 in the standard-introduction group (no one with egg) (Table S9 in the Supplementary Appendix). The rate of FPIES in the early-introduction group was 1.4% (7 of 486 participants), which is higher than expected [1][2][3] because data from populationbased birth-cohort studies showed a prevalence of FPIES of 0.3% associated with cow's milk proteins 2 and also showed that egg has not been identified as a prevalent causative agent. 3 These data suggest that the early introduction of cooked egg may be related to the occurrence of FPIES.…”

“…Then opinion changed, on the basis of scant evidence, 1 and by 1991 less than 20% of 2-monthold infants were getting semisolid food, as compared with more than 70% in 1976. 2 …”

“…To the Editor: Perkin and colleagues (May 5 issue) 1 find no evidence of efficacy of the early introduction of allergenic foods for the prevention of food allergy in the intention-to-treat analysis of their randomized trial. An apparent protective effect in the per-protocol analysis could be explained by the higher rate of nonadherence to the early-introduction protocol among infants in whom allergy symptoms developed (Table S14 in the Supplementary Appendix, available with the full text of the article at NEJM.org).…”