PURPOSE OF THE STUDY.
The goal of this study was to describe the demographic characteristics, clinical symptoms, and allergy test results in a large cohort of patients with food protein–induced enterocolitis syndrome (FPIES).
Patient charts were reviewed from The Children’s Hospital of Philadelphia, a large referral hospital with patients primarily from Pennsylvania, New Jersey, and Delaware.
This study was a retrospective chart review of electronic medical records from 2007 to 2012. Originally, 992 patients were identified as having “allergic gastroenteritis and colitis” according to International Classification of Diseases, Ninth Revision, coding. A total of 462 patients met the classic definition of FPIES with reproducible episodes of prolonged vomiting or diarrhea 2 to 6 hours after exposure to an inciting allergen. Patients with IgE-mediated food allergy and chronic symptoms (eg, chronic diarrhea) were excluded. Patch testing with foods (similar to contact allergy testing performed for nickel allergy) were conducted.
The patient population was primarily male (60%) and white (65%). Milk was the most common trigger food, with reactions reported in 67% of patients. The next most common food trigger was soy (41%), followed by grains (34.6%) and egg (11%). FPIES reactions were less common to meats and fish, vegetables and fruits, and peanut and tree nuts. A majority (70%) of patients reacted to 1 or 2 foods, and 5% reacted to >6 foods. Patients had their first FPIES reaction to milk and soy at ∼7 months of age compared with 12 months of age for solid foods. There was a relatively equal distribution between patients who presented with vomiting versus vomiting and diarrhea, and a minority (5%) presented with severe symptoms, including hypotension, pallor, or lethargy. Skin prick test results were negative in 96% of patients tested regardless of the food, and patch test results were negative 45% of the time over all foods. More than 85% of the patients had resolved their FPIES reactions by 5 years of age.
The data from this study confirm previous findings that a majority of FPIES reactions are due to milk and soy, and most patients experience resolution of this allergy early in life. It also confirms previous findings that results of skin prick tests are typically negative in FPIES. The results refute a previous pilot study that suggested utility of patch tests with foods. FPIES remains a clinical diagnosis with no simple method for testing.
This study is the largest of FPIES to date. The prevalence of this type of food allergy is unclear. Familiarity with FPIES is important because misdiagnosis is common, considering that symptoms may initially mimic infection or a surgical malady and results of typical allergy tests measuring IgE antibodies are characteristically negative.
- Copyright © 2014 by the American Academy of Pediatrics