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