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Characterization of food protein-induced enterocolitis syndrome among Asian American children
Charles Feng1, Priscilla Wong2, Satish Mudiganti3
1Division of Allergy/Immunology, Palo Alto Medical Foundation, Mountain View, California.
Insights
This study highlights unique features of food protein-induced enterocolitis syndrome (FPIES) in Asian American children, noting egg as a common trigger and fewer co-associations. Understanding these differences aids in diagnosing and managing FPIES in this diverse population.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Clinical Nutrition
Background:
- Limited data exists on food protein-induced enterocolitis syndrome (FPIES) clinical characteristics in Asian American (AsA) children.
- FPIES is a non-IgE mediated allergic reaction affecting the gastrointestinal tract.
Purpose of the Study:
- To evaluate a cohort of AsA children diagnosed with FPIES within a Northern California healthcare system.
- To identify specific clinical features and common trigger foods in this population.
Main Methods:
- Retrospective analysis of children under 18 diagnosed with FPIES between 2015 and 2022.
- Utilized patient/parent self-reported race/ethnicity and chart reviews by board-certified allergists.
- Performed market basket analysis to identify correlations among FPIES food categories.
Main Results:
- 146 cases of acute FPIES identified among 129,989 AsA children (0.11%).
- Most affected were males (52%) with atopic dermatitis (55.5%); median age at diagnosis was 7 months.
- Common culprit foods included egg (36.3%), oats (24%), and milk (16.4%); egg trigger was associated with a lack of avocado trigger (88% confidence).
Conclusions:
- This large pediatric AsA FPIES cohort exhibits distinct features, including a high prevalence of egg-induced FPIES.
- Lack of common food co-associations was observed, differing from other populations.
- Recognizing these clinical differences can improve FPIES diagnosis and management in the growing AsA population.
Background:
Limited data currently exist regarding the clinical characteristics of food protein-induced enterocolitis syndrome (FPIES) among Asian American (AsA) children.
Objective:
To evaluate a cohort of AsA children with FPIES in a Northern California health care system.
Methods:
We performed a retrospective analysis of children below 18 years of age with more than or equal to 1 outpatient clinical encounter with FPIES (International Classification of Diseases, 10th Revision, Clinical Modification, K52.21) diagnosed between October 1, 2015, and December 31, 2022. Patient/parent self-reported race/ethnicity was used. Two board-certified allergists reviewed the charts of all AsA children diagnosed with having FPIES. Market basket analysis was performed to identify correlations among FPIES food categories.
Results:
Of 129,989 AsA children, 146 (0.11%) had acute FPIES, most of which were male (52%) and had atopic dermatitis (55.5%). Median age at diagnosis was 7 months. Among 21 children (14%) who underwent oral food challenges, 66.6% (14/21) passed the challenge. Multi-food FPIES was observed in 23.9% (35/146) and atypical FPIES was observed in 14.4% (21/146) of the cohort. Approximately 28% of Asian Indian and 10% of Filipino children had more than 1 trigger food. The most common culprit foods included egg (36.3%), oats (24%), milk (16.4%), avocado (9.6%), rice (6.8%), and peanut (5.5%). Market basket analysis revealed that having an egg-related trigger was associated with not having an avocado-related trigger, with a confidence level of 88% and a lift value of 1.33.
Conclusion:
This large pediatric AsA FPIES cohort demonstrates distinguishing features, including a high proportion of egg FPIES and lack of common food co-associations. Understanding these clinical differences may significantly enhance clinicians' ability to diagnosis and manage FPIES among the rapidly growing heterogeneous AsA population.
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