Background: Fish is the most common causative food of food protein-induced enterocolitis syndrome (FPIES) in Southern Europe. In children with FPIES, the development of tolerance varies according to the culprit food and specifically fish seems to have a poorer prognosis than other solid foods. We sought to evaluate the fish-FPIES resolution rate in children. Methods: A descriptive retrospective analysis of children with fish-FPIES, followed during the last 20 years, was performed. The offending fish, age and symptoms at onset, the coexistence of atopic diseases and FPIES to other foods were registered. All the children included had undergone an oral food challenge (OFC) with the offending fish. We recorded those children that overcame their fish-FPIES and those that did not outgrow the disease. Results: Seventy children were enrolled in this study (median age: 9 yo; IQR 6.4-13.8). Forty-two (60%) achieved tolerance to the offending fish with a median age of 4 years (IQR: 3-5). Among children ≤5 yo (n = 40), 35 (87.5%) developed tolerance; among 6-8yo (n = 14), 40% developed tolerance; and only 12.5% among those ≥9 yo (n = 16) developed tolerance. Twenty-eight children did not outgrow the disease (median age: 8.9 yo; IQR: 9-13.8). We did not find any statistical differences regarding the offending fish, presence of single vs multiple fish-FPIES, symptoms at the beginning, coexistence of other atopic diseases or the coexistence of other FPIES, between the children who overcame the disease and those who did not. Conclusion: One in five children with FPIES to fish will not overcome the disease during childhood.

There exists a geographic barrier to access CIA care for patients who live in rural communities; telemedicine may bridge this gap in care. Herein we characterized the use of telemedicine in CIA at a population-based level and single centre. METHODS: Data were collected from the administrative database of Ontario Telemedicine Network (OTN) and from electronic medical records at a single academic centre during 2015 to 2019. The potential distance travelled and time saved by telemedicine visits were calculated using postal codes. RESULTS: During the five-year study period, a total of 952 telemedicine visits was conducted over OTN, with an average of 190 visits per year (range 127-291). The majority of visits were provided by a single academic centre, and chart review was performed to better characterize telemedicine use. In this cohort, 66% were female and the overall mean age was 47616. The most common diagnosis was immunodeficiency (39%), followed by asthma (14%) and urticaria (10%). Most patients required at least one follow-up via telemedicine. The average potential one-way distance travelled per visit was 359.3km (range 1.2-4218.0); the average potential time travelled in total was 6.6 hours. CONCLUSIONS: While telemedicine use in CIA has not been widely practiced in North America, it can be a cost-and time-saving tool to provide longitudinal care for patients with chronic diseases who live in rural communities. In light of the current pandemic, the study provides rationale for more physicians to adopt telemedicine use, and for healthcare agencies to support telemedicine as a strategic priority.

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