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Food protein-induced enterocolitis syndrome in Australia: A population-based study, 2012-2014
Sam Mehr1, Katie Frith2, Elizabeth H Barnes3
1Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, Australia.
Insights
Food protein-induced enterocolitis syndrome (FPIES) affects 15.4/100,000 infants in Australia, with rice being the most common trigger. Early onset and reactions to fruits/vegetables are linked to multiple food triggers in FPIES.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Epidemiology
Background:
- Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal allergic disorder.
- Large-scale population studies on FPIES incidence and characteristics are limited.
- Understanding FPIES prevalence is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the incidence of FPIES in Australian infants.
- To characterize the clinical features of FPIES in this population.
- To identify potential risk factors and common triggers for FPIES.
Main Methods:
- An Australia-wide survey conducted from 2012 to 2014.
- Utilized the Australian Paediatric Surveillance Unit for data collection.
- Involved monthly notifications of new acute FPIES cases in infants (<24 months) from 1400 pediatricians.
Main Results:
- Identified 230 infants with FPIES, yielding an incidence of 15.4/100,000/year.
- Median ages for first episode, diagnosis, and notification were 5, 7, and 10 months, respectively.
- Common triggers included rice (45%), cow's milk (33%), and egg (12%); 51% reacted upon first exposure.
Conclusions:
- FPIES is not rare in Australia, with a significant incidence rate.
- Rice is the predominant trigger for FPIES in Australian infants.
- Early disease onset and reactions to fruits/vegetables are associated with multiple food triggers in FPIES.
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.
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