Food protein‐induced enterocolitis syndrome: A large French multicentric experience

Abstract

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, and age of tolerance depending on the country of origin. We aimed at describing the characteristics of a French population of children with FPIES, and define risk factors for failure during challenge. Methods Data from 179 children who were referred for 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. Tolerance was defined as no adverse reaction after OFC or accidental exposure. 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 vs. 2.0, p = 0.01). Severe acute FPIES was a risk factor for delayed resolution (RR: 3.3 [1.2–9.2]), but not IgE sensitization. Performing a food challenge within 12 months after the first reaction increased the risk of failure (OR: 2.6 [1.1–6.6]). 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.

FPIES: Data for Germany in international comparison

“…In our study, this was true for 84% of all patients and, if only the children who reacted to cow’s milk were analyzed, even 90%. This also corresponds to the observations of other European studies where the proportion of children with only 1 FPIES trigger ranged from 70 to 94% [ 7 , 8 , 9 , 10 , 12 ]. In the German study, only 16% of patients had multiple triggers, of which 5% had more than 3 different triggers.…”

“…In Italy, Spain, Greece, the United Kingdom, and Sweden, fish was the most common trigger from the solid food group [ 7 , 8 , 9 , 12 , 16 ]. In France, egg [ 10 ], and in another study from the British Isles, fruit and vegetables [ 13 ] were mentioned as the most frequent triggers. Other common triggers in the European studies were oats, rice, and egg.…”

“…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 authors also summarized the main triggers of FPIES: worldwide, cow’s milk is reported by far the most. The other triggers differ depending on the region in which the study was conducted [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

Poultry Meat allergy: a Review of Allergens and Clinical Phenotypes

“…Over a 10-year period, 160 FPIES were diagnosed at a US center, 3 of which were attributed to chicken ingestion (1.9%) [64]. In a recent French series involving 179 patients where 10 patients had multiple FA, chicken was incriminated in 2/179 patients (1.1%) [65]. Poultry FPIES seem to resolve spontaneously, well before the resolution of fish allergy.…”