Clinical features and resolution of food protein–induced enterocolitis syndrome: 10-year experience

• Published in: Journal of allergy and clinical immunology Vol. 134; no. 2; pp. 382 - 389.e4
• Main Authors: Caubet, Jean Christoph, Ford, Lara Simone, Sickles, Laura, Järvinen, Kirsi M., Sicherer, Scott H., Sampson, Hugh A., Nowak-Węgrzyn, Anna
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.08.2014; Elsevier Limited
• Subjects: Adolescent; Adult; Age; allergic enterocolitis; Allergies; Allergy and Immunology; Animals; Cattle; Child; Child, Preschool; Diarrhea; Enterocolitis - complications; Enterocolitis - immunology; Enterocolitis - physiopathology; Family medical history; Female; Food; Food allergies; food allergy; Food Hypersensitivity - complications; Food Hypersensitivity - immunology; Food Hypersensitivity - physiopathology; food protein–induced enterocolitis; Food protein–induced enterocolitis syndrome; Humans; Immune Tolerance; Immunoglobulin E - blood; Infant; Male; Middle Aged; Milk; milk allergy; Milk Proteins - immunology; natural history; oat allergy; Oryza sativa; Patients; Prospective Studies; Proteins; rice allergy; soy allergy; Soybean Proteins - immunology; Studies; Syndrome; Time Factors; Food protein–induced enterocolitis syndrome; soy allergy; rice allergy; allergic enterocolitis; IQR; oat allergy; food allergy; natural history; OFC; milk allergy; FPIES; food protein–induced enterocolitis; ANC; SPT; Oral food challenge; Skin prick test; Absolute neutrophil count; Interquartile range
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2014.04.008

Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy. FPIES diagnosis is frequently delayed because of the absence of classic allergic symptoms and lack of biomarkers. We sought to characterize the clinical features and resolution of FPIES in patients evaluated in our practice. Subjects 6 months to 45 years of age with FPIES were prospectively recruited for oral food challenges (OFCs). Medical records were searched to identify the subjects who did not participate in OFCs. Among 160 subjects, 54% were male; median age at diagnosis was 15 months. We performed 180 OFCs to 15 foods in 82 subjects; 30% of the study population had FPIES confirmed based on OFC results. The most common foods were cow's milk (44%), soy (41%), rice (22.5%), and oat (16%). The majority (65%) reacted to 1 food, 26% reacted to 2 foods, and 9% reacted to 3 or more foods. The majority were atopic, and 39% had IgE sensitization to another food. Thirty-nine (24%) subjects had positive specific IgE levels to the food inducing FPIES. Among children with specific IgE to cow's milk, 41% changed from a milk FPIES to an IgE-mediated phenotype over time. The median age when tolerance was established was 4.7 years for rice, 4 years for oat, and 6.7 years for soy. Median age when milk tolerance was established for subjects with undetectable milk-specific IgE levels was 5.1 years, whereas none of the subjects with detectable milk-specific IgE became tolerant to milk during the study (P = .003). FPIES typically resolves by age 5 years. Milk FPIES, especially with detectable food-specific IgE, can have a protracted course and eventually transition to acute reactions.