PURPOSE OF THE STUDY.
To prospectively determine the prevalence, clinical characteristics, and natural history of food protein–induced enterocolitis (FPIES) in association with cow's milk protein (CMP).
In this birth-cohort study, 13 019 of 13 234 newborns (98.4%) born over a 2-year period from June 2004 to June 2006 were enrolled.
Information on reactions to CMP were obtained for all infants, and those with probable reactions were evaluated with skin-prick testing and oral challenge if clinically indicated. Criteria for CMP FPIES included onset at less than 9 months; vomiting, diarrhea, or both within 24 hours after the ingestion of milk in the absence of other immunoglobulin E (IgE)-mediated symptoms; and a positive challenge to milk that resulted in the symptoms listed above or removal of milk resulting in resolution of the symptoms.
The cumulative incidence of CMP FPIES was 0.34% (44 of 13 019). The most common symptoms were vomiting (100%), lethargy (77%), diarrhea (25%), pallor (14%), and bloody diarrhea (4.5%). All patients were diagnosed before the age of 6 months. Fifty percent of the cases resolved around the age of 1, and 90% resolved by age 3. Eight patients with FPIES had IgE-mediated milk allergy, and none had concomitant soy allergy.
The prevalence of FPIES is low but significant. Most patients with FPIES recover in early childhood. A significant proportion of CMP FPIES might convert to IgE-mediated milk allergy.
This study is unique because of its large size and prospective design. It provides much needed information on the prevalence and natural history of CMP FPIES and highlights the possible overlap between FPIES, which is considered a non–IgE-mediated allergy, and IgE-mediated milk allergy. Soy might be a reasonable alternative to hypoallergenic formulas in infants with CMP FPIES, although previous US studies revealed a higher rate of soy reactivity among infants with CMP FPIES.
- Copyright © 2011 by the American Academy of Pediatrics