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The natural history of food protein-induced enterocolitis syndrome (FPIES) is not well understood. We sought to examine factors which may influence time to and age of tolerance in our single-centre, tertiary cohort.
A retrospective cohort study of children with FPIES (using pre-defined criteria) who underwent observed food challenges (OFC) at The Children’s Hospital at Westmead from 1995-2015 was undertaken. Categorical and non-parametric analyses were performed.
We identified 67 OFCs on 59 infants with FPIES (median age at OFC=20 months). 14 (26%) reacted on OFC. Common food triggers were grains (n=37), cow’s milk (CM) (n=26), soy (n=12) and egg (n=12). There was no significant difference in sex, comorbid atopy, time between initial episodes and OFC or age at OFC between reactors and tolerant children.
Of children with grain-FPIES, 90% (34/37) were tolerant at OFC (median age at OFC=20 months; median time from initial episode=14 months). 88% of children with CM-FPIES (33/36) and 92% with soy-FPIES (11/12) were tolerant at OFC (median age at OFC=19 and 21 months; median time from initial episode=15 months and 21 months, respectively). By comparison, only 66% of children with egg-FPIES (8/12) and 50% (3/6) with fish-FPIES were tolerant at OFC (median age at OFC=36 and 47 months; median time from initial episode=33 and 34 months, respectively).
Most children with FPIES from our cohort attained tolerance earlier than 3-4 years. Certain foods were associated with a longer time to tolerance. Well-designed prospective studies are required to ensure children with FPIES do not undergo unnecessary prolonged dietary exclusion.