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Food Protein-induced Enterocolitis Syndrome (FPIES): Our Experience

      Rationale

      Food protein-induced enterocolitis syndrome (FPIES) is an uncommon, pediatric, non-immunoglobulin E(IgE)-mediated disorder triggered by the ingestion of food proteins.

      Methods

      Retrospective study over the past 12 years. 16 children, 10 boys/6 girls (age: 11months-12 years) diagnosed with FPIES by clinical history and/or oral challenge. Ulterior tolerance done by oral challenge.

      Results

      Skin prick test and specific serum IgE against the triggering food were negative. 50% of patients were atopic. Causative foods for the 16 children and the mean age of presentation were: milk (n=7) 4,7 months (all tolerate soja), fish (n=5) 14 months, gluten free cereals (n=1) 6 months, cereals containing gluten (n=1) 7months, soja milk (n=1) 6months, legumes (n=1) 20months, chicken (n=1) 7months. All presented symptoms after the first ingestion of the causative food except one.
      Mean episodes before diagnosis was 2.4. 5/16 patients(31%) had symptoms with more than one food.Mean time for symptoms to appear after ingestion was 2 hours.
      The most common clinical features were: vomiting(81%), diarrhea(56%), lethargy(19%), irritability(19%) ,pallor(13%) and underweight(13%). 6/16(37.5%) have good tolerance, demonstrated by oral challenge, after food avoidance diet: 3/7 tolerate milk (mean age tolerance MAT: 2.6 years), 2/5 tolerate fish (MAT: 7 years), 1/1 tolerates legumes(MAT: 7.3 years).

      Conclusions

      FPIES is a severe illness debuting in the first 2 years of life. Clinical suspicion is essential for an early diagnose. In our study milk and fish were the most common triggering foods. The mean age of resolution in our study is higher than that reported by other authors.