ABSTRACT WATCH: Food protein–induced enterocolitis syndrome

Food protein–induced enterocolitis syndrome in Australia: A population-based study, 2012-2014

Sam Mehr, MD, FRACP, Katie Frith, MD, FRACP, Elizabeth H. Barnes, BAppSc, MSta, Dianne E. Campbell, MD, PhD
Background

  • Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated gastrointestinal allergic disorder. Large population-based FPIES studies are lacking.

Objective

  • We sought to determine the incidence and clinical characteristics of FPIES in Australian infants.

Methods

  • An Australia-wide survey (2012-2014) was undertaken through the Australian Paediatric Surveillance Unit, with monthly notification of new cases of acute FPIES in infants aged less than 24 months by 1400 participating pediatricians.

Results

  • Two hundred thirty infants with FPIES were identified. The incidence of FPIES in Australian infants (<24 months) was 15.4/100,000/y. Median age of first episode, diagnosis, and notification were 5, 7, and 10 months, respectively. 
  • There was no sex predilection. Seven percent of infants had siblings with a history of FPIES, and 5% reacted during exclusive breast-feeding. Sixty-eight had a single food trigger (20% had 2 and 12% had ≥3 food triggers). The most common FPIES triggers were rice (45%), cow’s milk (33%), and egg (12%). Fifty-one percent of infants reacted on their first known exposure. Infants with FPIES to multiple versus single food groups were younger at the initial episode (4.6 vs 5.8 months [mean], P = .001) and more frequently had FPIES to fruits, vegetables, or both (66% vs 21%, P < .0001). 
  • Infants exclusively breast-fed for more than 4 months had a trend toward lower rates of FPIES to multiple food groups (23% vs 36%, P = .06). 
  • Sixty-four percent of infants with FPIES to multiple foods, which included cow’s milk, had coassociated FPIES to solid foods. Forty-two percent of infants with FPIES to fish reacted to other food groups.

Conclusions

  • FPIES is not rare, with an estimated incidence of 15.4/100,000/y. Rice is the most common food trigger in Australia. Factors associated with FPIES to multiple foods included early-onset disease and FPIES to fruits, vegetables, or both.

Key words:

  • Food protein–induced enterocolitis syndrome, infants, epidemiology, incidence, allergy
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