Clinical features and resolution of food protein–induced enterocolitis syndrome: 10-year experience - 01/08/14
Abstract |
Background |
Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy. FPIES diagnosis is frequently delayed because of the absence of classic allergic symptoms and lack of biomarkers.
Objective |
We sought to characterize the clinical features and resolution of FPIES in patients evaluated in our practice.
Methods |
Subjects 6 months to 45 years of age with FPIES were prospectively recruited for oral food challenges (OFCs). Medical records were searched to identify the subjects who did not participate in OFCs.
Results |
Among 160 subjects, 54% were male; median age at diagnosis was 15 months. We performed 180 OFCs to 15 foods in 82 subjects; 30% of the study population had FPIES confirmed based on OFC results. The most common foods were cow's milk (44%), soy (41%), rice (22.5%), and oat (16%). The majority (65%) reacted to 1 food, 26% reacted to 2 foods, and 9% reacted to 3 or more foods. The majority were atopic, and 39% had IgE sensitization to another food. Thirty-nine (24%) subjects had positive specific IgE levels to the food inducing FPIES. Among children with specific IgE to cow's milk, 41% changed from a milk FPIES to an IgE-mediated phenotype over time. The median age when tolerance was established was 4.7 years for rice, 4 years for oat, and 6.7 years for soy. Median age when milk tolerance was established for subjects with undetectable milk-specific IgE levels was 5.1 years, whereas none of the subjects with detectable milk-specific IgE became tolerant to milk during the study (P = .003).
Conclusion |
FPIES typically resolves by age 5 years. Milk FPIES, especially with detectable food-specific IgE, can have a protracted course and eventually transition to acute reactions.
Le texte complet de cet article est disponible en PDF.Key words : Food protein–induced enterocolitis syndrome, allergic enterocolitis, food protein–induced enterocolitis, food allergy, milk allergy, soy allergy, rice allergy, oat allergy, natural history
Abbreviations used : ANC, FPIES, IQR, OFC, SPT
Plan
| Supported in part by UL1 TR-000067 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. L.S.F. was supported by the Jaffe Foundation Fellowship Award, and K.M.J. was supported in part by the Leff Family Grant. |
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| Disclosure of potential conflict of interest: J. C. Caubet is employed by Geneva University Hospitals. L. S. Ford has received research support from the Jaffe Foundation. K. M. Järvinen has received research support from the National Institutes of Health and has received royalties from UpToDate. S. H. Sicherer is a member of the American Board of Allergy and Immunology, has received consultancy fees from Food Allergy Research and Education (FARE) and Novartis, has received research support from the National Institute of Allergy and Infectious Diseases (NIAID) and FARE, and has received royalties from UpToDate. H. A. Sampson has received research support from the NIAID/National Institutes of Health and from FARE (including funding supporting clinical trials in milk and wheat allergy); is Chair of the PhARF Award Review Committee; has received consultancy fees from Allertein Therapeutics, Regeneron, and the Danone Research Institute; and has received lecture fees from Thermo Fisher Scientific, UCB, and Pfizer. A. Nowak-Węgrzyn has received research support from Nestlé, the NIAID, FARE, Merck (DSMB), Nutricia, and Stallergens; has received royalties from UpToDate; and has received lecture fees from Thermo Fisher Scientific. L. Sickles declares that she has no relevant conflicts of interest. |
Vol 134 - N° 2
P. 382 - août 2014 Retour au numéro
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