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Evaluation of the Clinical Characteristics of Patients with Food Protein-Induced Enterocolitis Syndrome: A
Azize Pınar Metbulut1, Selime Özen2, Nergiz Kendirci3
1Division of Pediatric Allergy and Immunology, University of Health Sciences Ankara City Hospital, Ankara, Turkey.
Insights
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE food allergy affecting infants, often misdiagnosed. Cow's milk and egg are common triggers, with some children developing tolerance by 15 months.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Immunology
Background:
- Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-IgE-mediated food hypersensitivity.
- FPIES commonly affects infants and can be misdiagnosed due to its varied presentation.
- The underlying pathophysiology of FPIES remains incompletely understood.
Purpose of the Study:
- To characterize the demographic features of pediatric FPIES patients.
- To describe the clinical manifestations and common food triggers in FPIES.
- To report on the management and outcomes, including oral food challenge results, in children with FPIES.
Main Methods:
- Retrospective study of pediatric patients diagnosed with FPIES.
- Data collected from twelve pediatric allergy centers between January 2015 and November 2020.
- Inclusion of demographic, clinical, and management data, including oral food challenges.
Main Results:
- 73 pediatric patients were included, with symptom onset typically around 6 months.
- Cow's milk (38.4%), egg yolk (32.9%), fish (21.9%), and egg white (20.5%) were the most frequent triggers.
- Oral food challenges were performed in 54.8% of patients, with 42.5% showing tolerance by a median age of 15 months.
Conclusions:
- FPIES is a significant non-IgE food hypersensitivity in infants.
- Increased physician and parent education is crucial due to low awareness and potential misdiagnosis.
- Further research into FPIES pathophysiology is warranted.
Introduction:
Food protein-induced enterocolitis syndrome (FPIES) is a rare non-IgE, cell-mediated food allergy disorder. We aimed to report the demographic characteristics, clinical features, and management of pediatric patients with FPIES.
Methods:
This retrospective study included all children diagnosed with FPIES at the pediatric allergy departments of the participating twelve study centers from January 2015 to November 2020.
Results:
A total of 73 patients (39 males, 53.4%) with a male/female ratio of 1.1 were included in the study. The median (interquartile ranges) age at symptom onset was 6 months (0.5-168, 4-9.5). The most frequent offending foods were cow's milk, egg's yolk, fish, and egg's white, identified in 38.4% (n = 28), 32.9% (n = 24), 21.9% (n = 16) and 20.5% (n = 15) of the patients, respectively. The total number of reported FPIES episodes was 290 (3.9 episodes per child). Oral food challenge (OFC) was performed in 54.8% (n = 40) of the patients, and tolerance was detected in 17 OFCs (42.5%) at a median age of 15 months (range 8-132 months).
Conclusion:
FPIES is a non-IgE-mediated food hypersensitivity that commonly affects infants and is often misdiagnosed. The pathophysiology of the disease remains unclear and the low awareness of FPIES among physicians and parents highlights the need for more education.
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