Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 16;18(1):54.
doi: 10.1186/s13223-022-00694-y.

Food protein-induced enterocolitis syndrome in a tertiary pediatric center: safety of guideline-conforming food challenges

Samantha Wong  1 , Lucy Duan  1 , Alana Galper  1 , Adelle Atkinson  1 , Julia Upton  1 , Thomas Eiwegger  2   3   4   5
Affiliations

Food protein-induced enterocolitis syndrome in a tertiary pediatric center: safety of guideline-conforming food challenges

Samantha Wong et al. Allergy Asthma Clin Immunol. .

Abstract

Food protein-induced enterocolitis syndrome is a non-IgE-mediated reaction to food that is poorly understood, and underdiagnosed. Trigger foods can belong to any food group, but are most commonly milk, soy, rice, oat, egg, and fish. In this retrospective study (2015-2020), we describe the clinical presentations and triggers of 37 children referred to tertiary hospital with a confirmed or suspected diagnosis of food protein-inducted enterocolitis. We reviewed the safety of current recommendations by looking at the outcome of 24 oral food challenges. All of these patients presented with clear cut systemic reactions including lethargy. We also assessed the severity of the reactions. Oral food challenges occurred in the hospital day unit with the majority of patients having IV access in place. Despite a clear history of FPIES with lethargy and the requirement for re-hydration of the challenged population, 21/24 (88%) of the FPIES OFCs were successful. Of the three patients who reacted, symptoms were of moderate nature, mainly vomiting. This highlights the importance of early diagnosis and a pro-active approach to performing guideline-directed oral food challenges in patients with food protein-induced enterocolitis syndrome.

Keywords: FPIES; Food allergy; Non-IgE allergy; Oral food challenges.

PubMed Disclaimer

Conflict of interest statement

TE reports to act as local PI for company sponsored trials by DBV Therapeutics and sub-investigator for Regeneron and ALK. He holds grants from Innovation Fund Denmark, CIHR outside the submitted work. He is co-Investigator or scientific lead in three investigator initiated oral immunotherapy trials supported by the SickKids Food Allergy and Anaphylaxis Program and serves as associate editor for Allergy. He/his lab received unconditional/kind contributions from Macro Array Diagnostics and ALK Abello. He holds advisory board roles for ALK Abello. and Aimmune. JU reports research support/grants from Novartis, Regeneron, ALK, DBV Therapeutics, CIHR, SickKids Food Allergy and Anaphylaxis Program, and fees from Pfizer, ALK Abello, Bausch Health, Kaleo, Food Allergy Canada, all outside the submitted work. SW, LD, AG and AA have no conflicts of interest to declare.

References

    1. Leonard SA, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome. Pediatr Clin North Am. 2015;62(6):1463–1477. doi: 10.1016/j.pcl.2015.07.011. - DOI - PubMed
    1. Nowak-Wegrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111–26. doi: 10.1016/j.jaci.2016.12.966. - DOI - PubMed
    1. Nowak-Wegrzyn A, Berin MC, Mehr S. Food protein-induced enterocolitis syndrome. J Allergy Clin Immunol Pract. 2020;8(1):24–35. doi: 10.1016/j.jaip.2019.08.020. - DOI - PubMed
    1. Michelet M, Schluckebier D, Petit LM, Caubet JC. Food protein-induced enterocolitis syndrome—a review of the literature with focus on clinical management. J Asthma Allergy. 2017;10:197–207. doi: 10.2147/JAA.S100379. - DOI - PMC - PubMed
    1. Leonard SA, Pecora V, Fiocchi AG, Nowak-Wegrzyn A. Food protein-induced enterocolitis syndrome: a review of the new guidelines. World Allergy Organ J. 2018;11(1):4. doi: 10.1186/s40413-017-0182-z. - DOI - PMC - PubMed

LinkOut - more resources