Different Patterns of Foods Triggering FPIES in Germany

Food Protein-induced Enterocolitis Syndrome

“…Diagnostic criteria for FPIES according to the international guidelines were published in 2017. 1 According to the criteria, FPIES diagnosis consists of one major criterion and nine minor criteria, and acute FPIES is diagnosed when the major criterion and three First Second Third Fourth USA (35) Rice Cow's milk Oats Soy Australia (5) Rice Cow's milk Hen's egg Oats Spain (12) Cow's milk Fish Hen's egg Rice Italy (19) Cow's milk Fish Hen's egg Rice UK (11) Cow's milk Fish Hen's egg Soy, wheat Germany (13) Cow's milk Fish Beef Chicken Japan (10) Hen's egg Cow's milk Soy Wheat Korea (23) Soy Cow's milk of the nine minor criteria are met. The major criterion and nine minor criteria are as follows: major criterion includes vomiting within 1-4 h after ingesting the suspect causative food and the absence of classic IgE-mediated allergic skin or respiratory symptoms; the minor criteria include (1) a second (or more) episode of repetitive vomiting after eating the same suspect causative food, (2) an episode of repetitive vomiting 1-4 h after eating a different food, (3) extreme lethargy with any suspected reaction, (4) marked pallor with any suspected reaction, (5) need for emergency department visit with any suspected reaction, (6) need for intravenous fluid support with any suspected reaction, (7) diarrhea within 24 h (usually 5-10 h), ( 8) hypotension, and ( 9) hypothermia.…”

FPIES: Data for Germany in international comparison

“…Data on tolerance development in patients with FPIES are comparable worldwide [ 8 , 9 , 10 , 11 , 16 ]: those who reacted to cow’s milk became tolerant earliest, while those who reacted to solid foods did so later. In the German cohort, a difference in tolerance development was also found between children initially presenting with chronic versus acute FPIES: children with chronic FPIES were tolerant after a mean of 16.5 months, whereas those with acute FPIES were tolerant after 19.5 months [ 11 ].…”

“…The age of tolerance of children with reactions to vegetables was in between the two groups. Data on tolerance development to hen’s egg vary: in France, children were tolerant after a mean of 2.3 years [ 10 ], and in Germany and Italy [ 11 , 16 ] after ~ 5 years. Children who developed reactions to multiple triggers did not show delayed tolerance development [ 11 ].…”

“…Although infants with chronic FPIES often initially present in a poor condition, the prognosis is very good. The trigger of chronic FPIES in Germany was almost exclusively cow’s milk or cow’s milk formula [ 11 ]. Four children developed chronic FPIES under exclusive breast milk feeding.…”

“…Since no data on FPIES triggers had been available from Germany so far, the aim of a German retrospective multicenter study in 142 German children was the identification of the most frequent triggers in order to provide relevant feeding advice to families [ 11 ]. Furthermore, the development of tolerance depending on the triggering food, the number of triggers, the clinical presentation, and the presence of IgE sensitization to the trigger was investigated.…”