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Food protein-induced enterocolitis syndrome affects adults as well as children

Published: May 18, 2022

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by repetitive vomiting, which may be followed by diarrhea and in severe cases lethargy, hypotension, and metabolic derangements. It usually appears 1 to 4 hours after food intake. FPIES is classically described in the pediatric population, but it is increasingly recognized in adults. Diagnosing FPIES is challenging in general, but in the adult population, it is even more complex because numerous other conditions must be excluded, including irritable bowel syndrome (IBS) and enzymatic deficiencies such as lactose or fructose intolerance. In some cases, FPIES may coexist with these conditions.

In the current issue of The Journal of Allergy and Clinical Immunology: In Practice, Gonzalez-Delgado et al report on the clinical and demographic characteristics and the prognosis of a large series of adults with FPIES. The authors assessed the association with other gastrointestinal pathologies and explored factors that could play a role in the higher prevalence observed in women.

This 10-year (2010-2020) prospective study of 107 adults shows that FPIES may be a misdiagnosed disease, with relevant differences compared to the pediatric population. Abdominal pain was the most common symptom (96.3%), followed by diarrhea (72%) and vomiting (60.7%). There was a significant delay between symptoms onset and diagnosis, probably due to a low index of suspicion and patients’ own tendency to avoid consuming the culprit food. Moreover, only 15.9% sought medical care, suggesting that acute episodes in adults are less dramatic compared with children. The most common triggers were seafood (59.8%), egg (14%), and milk (10.3%), although onion, avocado, orange, and kiwi also caused reactions. A substantial proportion of patients (43.9%) reacted to more than one food group. In contrast to the good prognosis in the pediatric population, only 16.8% of adults had achieved tolerance after a median 3.5 years. A clear predominance in women was observed, perhaps due to hormonal factors. Adults with FPIES also had a higher-than-average prevalence of gastrointestinal pathologies. Oral food challenge was essential in patients with the multiple-food FPIES to rule out other gastrointestinal diseases.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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