[Food protein-induced enterocolitis syndrome (FPIES) in 14 children]

Area of Science:

• Pediatric Allergy
• Immunology
• Gastroenterology

Background:

• Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by acute vomiting, hypotonia, and lethargy.
• Delayed diagnosis is common due to a lack of awareness and initial misdiagnosis.
• FPIES can present acutely or chronically, with potential progression between forms and to IgE-mediated allergies.

Purpose of the Study:

• To describe the clinical characteristics, diagnosis, and management of acute FPIES in children.
• To highlight diagnostic challenges and delays in FPIES cases.
• To propose a treatment protocol for acute FPIES.

Main Methods:

• Retrospective descriptive study of children with acute FPIES.
• Data collected from allergy outpatient clinic at Nancy Regional University Hospital (November 2013 - June 2016).
• Analysis of patient demographics, triggering foods, symptom onset, diagnostic timelines, and treatment outcomes.

Main Results:

• Cow milk (50%) and fish (21.4%) were the most common triggers in 14 children; average symptom onset was 90 minutes post-ingestion.
• Average diagnosis time was 7.6 months, significantly shorter for milk than solid foods (1.4 vs. 12 months).
• Six children required hospitalization, one in intensive care; treatments included rehydration, corticosteroids, antihistamines, and antiemetics.

Conclusions:

• FPIES diagnosis is often delayed due to insufficient physician knowledge, underscoring the need for greater awareness.
• Progression from chronic to acute FPIES and from acute FPIES to IgE-mediated allergy can occur.
• Prompt recognition of vomiting, hypotonia, and lethargy is key for diagnosing acute FPIES, with a proposed treatment protocol to improve management.