Food protein-induced enterocolitis syndrome (FPIES) is a type of food allergy, which is non-IgE mediated. Repeated episodes of vomiting occurring 1 to 4 hours after consumption of the culprit food are a typical feature and can lead to dehydration and hypovolemic shock.

Researchers from France conducted a study to define the clinical characteristics of food protein-induced enterocolitis syndrome (FPIES) in children. Data from two tertiary centers between 2014 and 2020 was collected and retrospectively analysed. The study objective was to also define the risk factors for failure of oral food challenges (OFCs). Tolerance was described as no adverse reaction after accidental exposure or oral food challenge.

Among the 192 described FPIES, the age at first symptoms was 5.8 months. About 94.4% (n = 169) cases had single FPIES, while 5.6% (n=10) children had FPIES to many food groups.There were 23 culprit foods; the most common was cow’s milk (60.3%) followed by hen′s egg (16.2%) and fish (11.7%).  The overall age of resolution of FPIES for all foods was 2.2 years of age. But FPIES to fish resolved later than for milk ; 2.9 years vs 2.0, respectively. Resolution was delayed in children with severe acute FPIES, but not with IgE sensitization, with a risk ratio of 3.3. Conducting a food challenge within 12 months after the first reaction increased the risk of failure of the oral food challenge with odds ratio of 2.6; this was particularly seen in children with severe FPIES. Children who exhibited severe acute reactions were 3.3 times at high risk of persistent FPIES, which was more commonly seen for fish than for other foods.

In this study, cow’s milk was identified as the most common culprit food unlike in other studies, where fish, rice, oats, soy were most frequently involved foods. The overall prognosis is good as the condition resolved by 2 years of age. Children with FPIES to fish and those with severe acute FPIES showed delayed tolerance. 

Source: Lemoin A, et al. Clin Transl Allergy. 2022 Feb;12(2):e12112.