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Resolution of food protein-induced enterocolitis syndrome

Published: April 27, 2024

Food protein-induced enterocolitis syndrome (FPIES) is a severe food allergy that primarily affects infants and young children. Symptoms typically appear 1–4 hours after ingestion of the trigger food and include forceful repetitive emesis, pallor, lethargy and sometimes diarrhea. With age, patients may develop tolerance to their trigger food, allowing its reintroduction to their diet. To determine if tolerance has been achieved, the patient undergoes a medically supervised oral food challenge. A better understanding of the natural history of FPIES may help inform decisions about the optimal timing to offer oral food challenges.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Ullberg et al. sought to evaluate tolerance development in FPIES. The study was a long-term follow-up of a Swedish cohort of 113 children. Data on oral food challenges and FPIES resolution were collected through chart reviews, using a structured questionnaire. In cases with incomplete data, supplemental caregiver interviews were performed. Oral food challenge timing and protocol were chosen by the treating physician. The age of tolerance was defined as the age at which the patient ingested the food without symptoms, either after a medically supervised oral food challenge or after reintroduction of the trigger food at home.

The children were followed to a median age of 5.6 years. The most common trigger foods were cow’s milk (26%), fish (25%), oat (22%) and rice (8%). Most patients (73%) became tolerant by a median age of 36.0 months. In more than half of the patients (55%), tolerance was confirmed at home, either after planned reintroduction or by mistake. Milk- and oat-induced FPIES had favorable natural histories, with early resolution. Tolerance to fish occurred significantly later compared with all other foods. These findings increase clinical knowledge about the natural course of FPIES and can be useful for developing guidelines for oral food challenge timing, to minimize unnecessary dietary restrictions and avoid troublesome reactions.

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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