Mehr SS, Kakakios AM, Kemp AS. Arch Dis Child. 2009;94(3):220–223
PURPOSE OF THE STUDY. To examine the characteristics of children presenting with food protein-induced enterocolitis syndrome (FPIES) attributable to rice and to determine whether there were any differences from those presenting with cow's milk and/or soy FPIES.
STUDY POPULATION. Retrospective study of 31 children presenting with FPIES (14 with rice and 17 with milk/soy) to the Children's Hospital at Westmead, Australia, during a 16-year period (1992–2007).
METHODS. Possible cases of FPIES were identified from the hospital medical record database and from electronically stored departmental letters written by allergists/immunologists. Previously published criteria were used for the diagnosis of FPIES, and cases were differentiated into typical and atypical presentations. The Mann-Whitney U test or Student's t test was used for comparisons between nonparametric and parametric continuous variables. P < .05 was considered significant.
RESULTS. There were 14 children with 26 episodes of rice FPIES, compared with 17 children with 30 episodes of cow's milk (n = 10) and soy (n = 7) FPIES. Children with rice FPIES were more likely to have FPIES caused by another food (36%) than were children with FPIES caused by cow's milk/soy (0%). Rice triggered more severe reactions, resulting in higher rates of intravenous fluid resuscitation (42% vs 17%), compared with reactions caused by cow's milk/soy.
CONCLUSIONS. This study emphasizes the emerging importance of rice, a food commonly thought to be “hypoallergenic,” as a significant trigger of FPIES. Episodes triggered by rice caused more severe reactions requiring intravenous fluid resuscitation than did episodes caused by cow's milk or soy.
REVIEWERS COMMENTS. Clinicians who take care of infants should be aware that rice can cause FPIES and such reactions may be more severe than those caused by cow's milk and/or soy. The clinical presentation can mimic sepsis or an intraabdominal surgical emergency. It is important to consider the diagnosis of rice FPIES, particularly when evaluating children 3 to 6 months of age presenting with vomiting and/or diarrhea ∼2 hours after ingesting the suspect food. Infants with rice FPIES tend to have multiple episodes, to have more severe reactions, and to require admissions to the hospital before the final diagnosis is correctly made.
- Copyright © 2009 by the American Academy of Pediatrics