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.

Keywords: FPIES; France; children; frankreich; kinder; schwere; severity; tolerance; toleranz.

FIGURE 1

Flow chart. *Multiple FPIES n = 10: (1) acute confirmed form to soy and chronic confirmed to cow's milk; (2) acute confirmed form to maize and hen's egg and chronic confirmed to cow's milk; (3) acute confirmed form to cow's milk, chicken, hen's egg and green beans; (4) acute confirmed form to cow's milk and acute presumptive form to beef; (5) acute confirmed form to tomato and coconut; (6) acute presumptive form to hen's egg and rice; (7) acute confirmed form to beef and chronic confirmed form to cow's milk; (8) acute confirmed form to rice and banana; (9) acute confirmed form to cow's milk and raspberries; (10) acute confirmed form to avocado and cashew nuts

FIGURE 2

Repartition of patients according to the offending foods. Milk: n = 108; Hen's egg: n = 29; Fish: n = 21; Fruits: n = 10 (apple, apricot, avocado, banana, cashew nuts, and coconut (n = 2), pineapple, raspberry, and tomato); Cereals: n = 8 (maize, rice and rice hydrolysate (n = 6), wheat); Vegetables: n = 8 (broccoli, cucurbits (n = 2), green beans, mushroom (n = 2), sweet potato (n = 2)); Meat: n = 5 (beef (n = 3), chicken (n = 2)); Legumes: n = 3 (green peas, peanut, and soy). Total: 179 patients included 10 patients with multiple FPIES, that is 192 FPIES

FIGURE 3

Overall Kaplan–Meier survival curve

FIGURE 4

Kaplan–Meier survival curves for milk, solid food, hen's egg, fish and likelihood of FPIES resolution by age and food. Milk: likelihood of FPIES resolution by 1 year of age: 5.6%; by 2 years of age: 42.8%; by 3 years of age: 70.9%; by 5 years of age: 90.7%; Solid foods: likelihood of FPIES resolution by 1 year of age: 2.5%; by 2 years of age: 24.4%; by 3 years of age: 52.7%; by 5 years of age: 66.2%; Hen's egg: likelihood of FPIES resolution by 1 year of age: 3.5%; by 2 years of age: 40.0%; by 3 years of age: 74.3%; by 5 years of age: 87.1%; Fish: likelihood of FPIES resolution by 1 year of age: 4.7%; by 2 years of age: 14.3%; by 5 years of age: 38.1%; by 10 years of age: 56.7%