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Food protein-induced enterocolitis syndrome: insights from review of a large referral population.

Abstract

BACKGROUND

Food protein-induced enterocolitis (FPIES) is a rare non-IgE mediated disease. Most studies have been limited in nature, with the largest cohort being 66 patients. The most common foods that have been reported are milk and soy.

OBJECTIVE

A retrospective chart review of patients seen in the Allergy Section at The Children's Hospital of Philadelphia with International Classification of Diseases Ninth Revision code of 558.3 (Allergic Gastroenteritis and Colitis) between 2007 and 2012 was conducted to identify patients with suspected FPIES. Diagnosis of FPIES was confirmed based on meeting clinical criteria of delayed reaction with pronounced vomiting and/or diarrhea. Data regarding patient characteristics and features of their reactions were collected for analysis and comparison with existing studies.

RESULTS

A total of 462 cases were identified in our chart review. Patients had a similar demographic profile to the normal allergy patients seen in our clinic. The most common foods identified were milk (67%), soy (41%), rice (19%), oat (16%), and egg (11%). Patients had onset of FPIES to milk and soy around 7 months of age compared with 12 months of age for solid foods. FPIES reactions were identified to meats, tree nuts, peanuts, fruits, and vegetables; 70% of the patients reacted to one or two foods. Skin prick testing and atopy patch testing were not helpful in identifying the foods.

CONCLUSION

FPIES reactions were seen more frequently than previously described. However, the presentation and clinical features were similar to previous reports. Milk- and soy-triggered FPIES were common, and 43.5% of patients who had a milk trigger reacted to soy. There is no laboratory test to identify foods that cause FPIES, and clinician-supervised oral food challenge is the only definitive test available.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.

    ,

    Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa.

    ,

    Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa; Allergy and Clinical Immunology Unit, Pediatric, A. Meyer Children's Hospital, Florence, Italy.

    ,

    Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa.

    ,

    Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa.

    Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: spergel@email.chop.edu.

    Source

    MeSH

    Age of Onset
    Child, Preschool
    Dietary Proteins
    Enterocolitis
    Female
    Food Hypersensitivity
    Humans
    Infant
    Male
    Referral and Consultation
    Retrospective Studies
    Syndrome

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    24565539

    Citation

    Ruffner, Melanie A., et al. "Food Protein-induced Enterocolitis Syndrome: Insights From Review of a Large Referral Population." The Journal of Allergy and Clinical Immunology. in Practice, vol. 1, no. 4, 2013, pp. 343-9.
    Ruffner MA, Ruymann K, Barni S, et al. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013;1(4):343-9.
    Ruffner, M. A., Ruymann, K., Barni, S., Cianferoni, A., Brown-Whitehorn, T., & Spergel, J. M. (2013). Food protein-induced enterocolitis syndrome: insights from review of a large referral population. The Journal of Allergy and Clinical Immunology. in Practice, 1(4), pp. 343-9. doi:10.1016/j.jaip.2013.05.011.
    Ruffner MA, et al. Food Protein-induced Enterocolitis Syndrome: Insights From Review of a Large Referral Population. J Allergy Clin Immunol Pract. 2013;1(4):343-9. PubMed PMID: 24565539.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Food protein-induced enterocolitis syndrome: insights from review of a large referral population. AU - Ruffner,Melanie A, AU - Ruymann,Kathryn, AU - Barni,Simona, AU - Cianferoni,Antonella, AU - Brown-Whitehorn,Terri, AU - Spergel,Jonathan M, Y1 - 2013/06/28/ PY - 2013/03/14/received PY - 2013/05/11/revised PY - 2013/05/28/accepted PY - 2014/2/26/entrez PY - 2014/2/26/pubmed PY - 2014/5/28/medline KW - Diarrhea KW - FPIES KW - Food Allergy KW - Food protein–induced enterocolitis syndrome KW - Vomiting SP - 343 EP - 9 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract VL - 1 IS - 4 N2 - BACKGROUND: Food protein-induced enterocolitis (FPIES) is a rare non-IgE mediated disease. Most studies have been limited in nature, with the largest cohort being 66 patients. The most common foods that have been reported are milk and soy. OBJECTIVE: A retrospective chart review of patients seen in the Allergy Section at The Children's Hospital of Philadelphia with International Classification of Diseases Ninth Revision code of 558.3 (Allergic Gastroenteritis and Colitis) between 2007 and 2012 was conducted to identify patients with suspected FPIES. Diagnosis of FPIES was confirmed based on meeting clinical criteria of delayed reaction with pronounced vomiting and/or diarrhea. Data regarding patient characteristics and features of their reactions were collected for analysis and comparison with existing studies. RESULTS: A total of 462 cases were identified in our chart review. Patients had a similar demographic profile to the normal allergy patients seen in our clinic. The most common foods identified were milk (67%), soy (41%), rice (19%), oat (16%), and egg (11%). Patients had onset of FPIES to milk and soy around 7 months of age compared with 12 months of age for solid foods. FPIES reactions were identified to meats, tree nuts, peanuts, fruits, and vegetables; 70% of the patients reacted to one or two foods. Skin prick testing and atopy patch testing were not helpful in identifying the foods. CONCLUSION: FPIES reactions were seen more frequently than previously described. However, the presentation and clinical features were similar to previous reports. Milk- and soy-triggered FPIES were common, and 43.5% of patients who had a milk trigger reacted to soy. There is no laboratory test to identify foods that cause FPIES, and clinician-supervised oral food challenge is the only definitive test available. SN - 2213-2198 UR - https://www.unboundmedicine.com/medline/citation/24565539/Food_protein_induced_enterocolitis_syndrome:_insights_from_review_of_a_large_referral_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(13)00233-X DB - PRIME DP - Unbound Medicine ER -