Published online February 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e459-e464 (doi:10.1542/peds.2008-2029)

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ARTICLE

Food Protein-Induced Enterocolitis Syndrome: 16-Year Experience

Sam Mehr, BMedSci, FRACP, FRCPA^a,b, Alyson Kakakios, FRACP^a, Katie Frith, MBBS, MRCPCH^b,c and Andrew S. Kemp, FRACP, PhD^a,b

^a Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, Australia
^b Discipline of Paediatrics and Child Health, Clinical School, University of Sydney, Sydney, Australia
^c Australian Paediatric Surveillance Unit, Sydney, Australia

Objective. The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced enterocolitis syndrome.

Methods. This was a retrospective study of children with food protein-induced enterocolitis syndrome who presented to the Children's Hospital at Westmead (Sydney, Australia) over 16 years.

Results. Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of <36°C at presentation was recorded for 24% of episodes. A platelet count of >500 x 10⁹ cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age.

Conclusions. Misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome.

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Key Words: food protein-induced enterocolitis syndrome • vomiting • diarrhea • misdiagnosis

Abbreviations: IgE—immunoglobulin E • ED—emergency department • CHW—Children's Hospital at Westmead • FPIES—food protein-induced enterocolitis syndrome • SPT—skin prick test

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Accepted Dec 2, 2008.

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