Epidemiology of food protein-induced enterocolitis syndrome

Abstract

Purpose of review: To summarize the epidemiology of food protein-induced enterocolitis syndrome (FPIES).

Recent findings: FPIES 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.

Summary: FPIES 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?

Box 1

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FIGURE 1

Causative triggers of food protein-induced enterocolitis syndrome in infants (%). Data derived from case series from the USA [7,9,24,27,30^▪], Australia and Italy/Spain [31^▪]. Only case series examining acute FPIES reactions to all foods included. Cases from Italy (n = 66) and Spain (n = 16) combined. Some children had FPIES to more than one food trigger. ^∗Rice was the commonest grain trigger (Australia 44%, USA 19% and Italy/Spain 4%), followed by oats (Australia 7%, USA 16% and Italy/Spain 0%).

FIGURE 2

Infants with food protein-induced enterocolitis syndrome to single or multiple different food triggers. Data derived from case series from the USA [7,9,24,27,30^▪], Australia and Italy/Spain [31^▪]. Only case series examining acute FPIES reactions to all foods included. Cases from Italy (n = 66) and Spain (n = 16) combined.