Food protein-induced enterocolitis syndrome in children: A swiss prospective multicenter study

Reto Villiger ¹, Alena Kuhn ^2,3, Peter Eng ⁴

⁰Department of Paediatrics, Hospital Center of Biel, Biel, Switzerland.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology +

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January 12, 2026

View abstract on PubMed

Summary

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. This study in Swiss children found acute FPIES to single foods most common, with tolerance development varying by trigger food and clinical presentation.

Area Of Science

Pediatric Allergy and Immunology
Gastroenterology
Clinical Nutrition

Background

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by gastrointestinal symptoms.
Understanding FPIES phenotypes and outcomes is crucial for effective management in children.

Purpose Of The Study

To analyze the diverse clinical phenotypes of FPIES in a Swiss pediatric cohort.
To investigate the outcomes and tolerance development associated with different FPIES presentations.

Main Methods

A prospective observational study was conducted across four Swiss pediatric clinics between 2019 and 2024.
Ninety-eight children with a total of 121 FPIES diagnoses were enrolled.

Main Results

The most frequent phenotype was acute FPIES to a single food (71%), with cow's milk, hen's egg, and fish being common triggers.
Chronic FPIES occurred in 14% of cases. A subset showed a phenotype switch to IgE-mediated allergy, particularly with cow's milk.
Median age of resolution varied: 11 months for chronic FPIES and 4.8 years for acute FPIES, with significant differences based on trigger foods.

Conclusions

Acute FPIES to a single food is the predominant presentation in Swiss children.
Tolerance development in FPIES is influenced by the specific trigger foods and the clinical phenotype observed.
FPIES management and prognosis are linked to distinct clinical characteristics and food triggers.

Keywords:

FPIES with IgE‐mediated reactions chronic FPIES food protein‐induced enterocolitis syndrome phenotype switch