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. 2017 Nov;140(5):1323-1330.
doi: 10.1016/j.jaci.2017.03.027. Epub 2017 Apr 18.

Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012-2014

Sam Mehr  1 , Katie Frith  2 , Elizabeth H Barnes  3 , Dianne E Campbell  4 ; FPIES Study Group
Collaborators, Affiliations

Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012-2014

Sam Mehr et al. J Allergy Clin Immunol. 2017 Nov.

Abstract

Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal allergic disorder. Large population-based FPIES studies are lacking.

Objective: We sought to determine the incidence and clinical characteristics of FPIES in Australian infants.

Methods: An Australia-wide survey (2012-2014) was undertaken through the Australian Paediatric Surveillance Unit, with monthly notification of new cases of acute FPIES in infants aged less than 24 months by 1400 participating pediatricians.

Results: Two hundred thirty infants with FPIES were identified. The incidence of FPIES in Australian infants (<24 months) was 15.4/100,000/y. Median age of first episode, diagnosis, and notification were 5, 7, and 10 months, respectively. There was no sex predilection. Seven percent of infants had siblings with a history of FPIES, and 5% reacted during exclusive breast-feeding. Sixty-eight had a single food trigger (20% had 2 and 12% had ≥3 food triggers). The most common FPIES triggers were rice (45%), cow's milk (33%), and egg (12%). Fifty-one percent of infants reacted on their first known exposure. Infants with FPIES to multiple versus single food groups were younger at the initial episode (4.6 vs 5.8 months [mean], P = .001) and more frequently had FPIES to fruits, vegetables, or both (66% vs 21%, P < .0001). Infants exclusively breast-fed for more than 4 months had a trend toward lower rates of FPIES to multiple food groups (23% vs 36%, P = .06). Sixty-four percent of infants with FPIES to multiple foods, which included cow's milk, had coassociated FPIES to solid foods. Forty-two percent of infants with FPIES to fish reacted to other food groups.

Conclusions: FPIES is not rare, with an estimated incidence of 15.4/100,000/y. Rice is the most common food trigger in Australia. Factors associated with FPIES to multiple foods included early-onset disease and FPIES to fruits, vegetables, or both.

Keywords: Food protein–induced enterocolitis syndrome; allergy; epidemiology; incidence; infants.

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