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Food protein-induced enterocolitis syndrome: 16-year experience.
Pediatrics 2009; 123(3):e459-64Ped

Abstract

OBJECTIVE

The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced enterocolitis syndrome.

METHODS

This was a retrospective study of children with food protein-induced enterocolitis syndrome who presented to the Children's Hospital at Westmead (Sydney, Australia) over 16 years.

RESULTS

Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of <36 degrees C at presentation was recorded for 24% of episodes. A platelet count of >500 x 10(9) cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age.

CONCLUSIONS

Misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome.

Authors+Show Affiliations

Department of Allergy and Immunology, Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales, Australia 2145. samm@chw.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19188266

Citation

Mehr, Sam, et al. "Food Protein-induced Enterocolitis Syndrome: 16-year Experience." Pediatrics, vol. 123, no. 3, 2009, pp. e459-64.
Mehr S, Kakakios A, Frith K, et al. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123(3):e459-64.
Mehr, S., Kakakios, A., Frith, K., & Kemp, A. S. (2009). Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics, 123(3), pp. e459-64. doi:10.1542/peds.2008-2029.
Mehr S, et al. Food Protein-induced Enterocolitis Syndrome: 16-year Experience. Pediatrics. 2009;123(3):e459-64. PubMed PMID: 19188266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Food protein-induced enterocolitis syndrome: 16-year experience. AU - Mehr,Sam, AU - Kakakios,Alyson, AU - Frith,Katie, AU - Kemp,Andrew S, Y1 - 2009/02/02/ PY - 2009/2/4/entrez PY - 2009/2/4/pubmed PY - 2009/3/31/medline SP - e459 EP - 64 JF - Pediatrics JO - Pediatrics VL - 123 IS - 3 N2 - OBJECTIVE: The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced enterocolitis syndrome. METHODS: This was a retrospective study of children with food protein-induced enterocolitis syndrome who presented to the Children's Hospital at Westmead (Sydney, Australia) over 16 years. RESULTS: Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of <36 degrees C at presentation was recorded for 24% of episodes. A platelet count of >500 x 10(9) cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age. CONCLUSIONS: Misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/19188266/Food_protein_induced_enterocolitis_syndrome:_16_year_experience_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=19188266 DB - PRIME DP - Unbound Medicine ER -