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. 2025 Mar;36(3):e70058.
doi: 10.1111/pai.70058.

The prevalence of peanut-triggered food protein-induced enterocolitis syndrome in a prospective cohort of infants introducing peanut in the first year of life

Dirk H J Verhoeven  1   2 , Geertje Hofstra  3 , Joyce Faber  4 , Olga Benjamin-van Aalst  5 , Mijke Breukels  6 , Tom Hendriks  7 , Roy Gerth van Wijk  2 , Hans de Groot  1
Affiliations

The prevalence of peanut-triggered food protein-induced enterocolitis syndrome in a prospective cohort of infants introducing peanut in the first year of life

Dirk H J Verhoeven et al. Pediatr Allergy Immunol. 2025 Mar.

Abstract

Background: Since the early introduction of peanut to prevent IgE-mediated peanut allergy, other case series have suggested an increased incidence of peanut-triggered Food Protein Induced Enterocolitis Syndrome (FPIES). Data on the prevalence of peanut-induced FPIES in prospective cohorts are lacking.

Methods: The PeanutNL cohort is a prospective cohort that included infants at risk of peanut allergy (n = 706) as well as infants with reactions to peanut at home after early introduction (n = 186). They all introduced peanut before the age of 12 months. Oral food challenges were performed to introduce peanut or to evaluate reactions to peanut at home.

Results: Of the 706 infants that were included for first introduction of peanut, 2 had reactions with a phenotype compatible with FPIES (0.3%). Of the 186 infants with reactions to peanut at home, 6 were diagnosed with FPIES (3.2%). Seven out of 8 cases had ingestions of peanut without reactions at home or during clinical introduction before FPIES became apparent. During a 3-year follow-up, six infants (75%) were shown to be tolerant to peanut before the age of 3 years.

Conclusion: The prevalence of challenge-proven peanut-induced FPIES in a Dutch cohort of atopic infants that introduced peanut between the ages of 4 and 11 months is 0.3%. The majority of cases were tolerant to peanut before the age of 3 years. When introducing peanut in the first year of life, physicians should be aware of FPIES reactions, but it should not be a reason to avoid early introduction of peanut.

Keywords: FPIES; early introduction; infants; peanut allergy; prevention.

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Conflict of interest statement

The authors have no conflicting interests to disclose.

Figures

FIGURE 1
FIGURE 1
Overview of peanut FPIES in the PeanutNL cohort. A total of 8 peanut‐induced FPIES cases were identified. All 8 infants had negative skin prick tests to peanut. The prevalence of peanut‐induced FPIES in the subgroup that did not have reactions to peanut before the study visit was 2 out of 706 (0.3%). *Two infants had inconclusive challenge results after a second challenge due to refusal to eat the peanut containing matrix.
See this image and copyright information in PMC

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