Food Protein-induced Enterocolitis Syndrome: A Large French Multicentric Experience

Overview

Journal Clin Transl Allergy

Publisher Wiley

Specialty Allergy & Immunology

Date 2022 Feb 26

PMID 35218323

Authors

Anais Lemoine

Anne-Sophie Colas

Sebastien LE

Christophe Delacourt

Patrick Tounian

Guillaume Lezmi

Affiliations

Soon will be listed here.

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.

Citing Articles

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PMID: 39071726 PMC: 11274009. DOI: 10.1177/23333928241264020.

Recent Update in Food Protein-Induced Enterocolitis Syndrome: Pathophysiology, Diagnosis, and Management.

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FPIES: Data for Germany in international comparison.

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Food protein-induced enterocolitis syndrome: A large French multicentric experience.

Lemoine A, Colas A, LE S, Delacourt C, Tounian P, Lezmi G Clin Transl Allergy. 2022; 12(2):e12112.

PMID: 35218323 PMC: 8850996. DOI: 10.1002/clt2.12112.

References

Mehr S, Kakakios A, Frith K, Kemp A . Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009; 123(3):e459-64. DOI: 10.1542/peds.2008-2029. View

Ruffner M, Wang K, Dudley J, Cianferoni A, Grundmeier R, Spergel J . Elevated Atopic Comorbidity in Patients with Food Protein-Induced Enterocolitis. J Allergy Clin Immunol Pract. 2019; 8(3):1039-1046. PMC: 7064432. DOI: 10.1016/j.jaip.2019.10.047. View

Caubet J, Bencharitiwong R, Ross A, Sampson H, Berin M, Nowak-Wegrzyn A . Humoral and cellular responses to casein in patients with food protein-induced enterocolitis to cow's milk. J Allergy Clin Immunol. 2016; 139(2):572-583. DOI: 10.1016/j.jaci.2016.02.047. View

Miceli Sopo S, Bersani G, Cerchiara G, Monaco S . Oral food challenge with a mixture of 'at risk' foods in children with FPIES. Pediatr Allergy Immunol. 2016; 27(8):874-876. DOI: 10.1111/pai.12623. View

Papadopoulou A, Lagousi T, Hatzopoulou E, Korovessi P, Kostaridou S, Mermiri D . Atypical food protein-induced enterocolitis syndrome in children: Is IgE sensitisation an issue longitudinally?. Allergol Immunopathol (Madr). 2021; 49(3):73-82. DOI: 10.15586/aei.v49i3.79. View

Ludman S, Harmon M, Whiting D, Du Toit G . Clinical presentation and referral characteristics of food protein-induced enterocolitis syndrome in the United Kingdom. Ann Allergy Asthma Immunol. 2014; 113(3):290-4. DOI: 10.1016/j.anai.2014.06.020. View

Steinegger L, Regenass S, Bachmann L, Probst E, Steiner U . Atopy and related clinical symptoms among Swiss medical students from 2007 to 2015. Allergy Asthma Clin Immunol. 2018; 14:4. PMC: 5795859. DOI: 10.1186/s13223-018-0230-4. View

Maciag M, Bartnikas L, Sicherer S, Herbert L, Young M, Matney F . A Slice of Food Protein-Induced Enterocolitis Syndrome (FPIES): Insights from 441 Children with FPIES as Provided by Caregivers in the International FPIES Association. J Allergy Clin Immunol Pract. 2020; 8(5):1702-1709. PMC: 7217717. DOI: 10.1016/j.jaip.2020.01.030. View

Nowak-Wegrzyn A, Berin M, 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. View

10.

Fogg M, Brown-Whitehorn T, Pawlowski N, Spergel J . Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. 2006; 17(5):351-5. DOI: 10.1111/j.1399-3038.2006.00418.x. View

11.

Nowak-Wegrzyn A, Chehade M, Groetch M, Spergel J, Wood R, Allen K . 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):1111-1126.e4. DOI: 10.1016/j.jaci.2016.12.966. View

12.

Blackman A, Anvari S, Davis C, Anagnostou A . Emerging triggers of food protein-induced enterocolitis syndrome: Lessons from a pediatric cohort of 74 children in the United States. Ann Allergy Asthma Immunol. 2019; 122(4):407-411. DOI: 10.1016/j.anai.2019.01.022. View

13.

Xepapadaki P, Kitsioulis N, Manousakis E, Manolaraki I, Douladiris N, Papadopoulos N . Remission Patterns of Food Protein-Induced Enterocolitis Syndrome in a Greek Pediatric Population. Int Arch Allergy Immunol. 2019; 180(2):113-119. DOI: 10.1159/000500860. View

14.

Katz Y, Goldberg M, Rajuan N, Cohen A, Leshno M . The prevalence and natural course of food protein-induced enterocolitis syndrome to cow's milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011; 127(3):647-53.e1-3. DOI: 10.1016/j.jaci.2010.12.1105. View

15.

Lee E, Barnes E, Mehr S, Campbell D . An exploration of factors associated with food protein-induced enterocolitis syndrome: Birth, infant feeding and food triggers. Pediatr Allergy Immunol. 2021; 32(4):742-749. DOI: 10.1111/pai.13448. View

16.

Lemoine A, Colas A, LE S, Delacourt C, Tounian P, Lezmi G . Food protein-induced enterocolitis syndrome: A large French multicentric experience. Clin Transl Allergy. 2022; 12(2):e12112. PMC: 8850996. DOI: 10.1002/clt2.12112. View

17.

Sicherer S, Eigenmann P, Sampson H . Clinical features of food protein-induced enterocolitis syndrome. J Pediatr. 1998; 133(2):214-9. DOI: 10.1016/s0022-3476(98)70222-7. View

18.

Adel-Patient K, Lezmi G, Castelli F, Blanc S, Bernard H, Soulaines P . Deep analysis of immune response and metabolic signature in children with food protein induced enterocolitis to cow's milk. Clin Transl Allergy. 2018; 8:38. PMC: 6161449. DOI: 10.1186/s13601-018-0224-9. View

19.

Bellon Alonso S, Ezquiaga J, Berzal P, Tardon S, San Jose M, Lopez P . Food protein-induced enterocolitis syndrome: Increased prevalence of this great unknown-results of the PREVALE study. J Allergy Clin Immunol. 2018; 143(1):430-433. DOI: 10.1016/j.jaci.2018.08.045. View

20.

Mehr S, Frith K, Barnes E, Campbell D . Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012-2014. J Allergy Clin Immunol. 2017; 140(5):1323-1330. DOI: 10.1016/j.jaci.2017.03.027. View