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Differences between patients who met the FPIES criteria or not

Published: March 14, 2024

Some patients with food protein-induced enterocolitis (FPIES)-like allergy do not completely fulfill the diagnostic criteria proposed in the international consensus guideline in 2017 (the 2017 criteria). However, it is unclear whether such FPIES-like patients represent a completely different population from FPIES or not.

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Hayashi and colleagues conducted a cross-sectional study that analyzed the data at the time of registration in the multicenter, prospective observational study of Japanese FPIES patients at 10 medical institutions in order to clarify the differences in characteristics between the FPIES patients who fully met the diagnostic criteria and those who partly met them. The authors included patients who met the major criterion of the 2017 criteria as acute FPIES patients. The recruited children were then further divided into 2 groups. One group fully met the 2017 criteria (Fully met), and the other group did not meet the full criteria but met the major criterion and had a second or more vomiting episodes (Partly met). The clinical characteristics, including trigger foods, age of onset, provoked symptoms, emergency room visits, treatment with infusion, sex, comorbidities including other allergic diseases perinatal information including birth weight, gestational age, mode of delivery, and allergic history of the parents, were compared between two groups. Particularly in patients with hen’s egg FPIES, the serving size of egg yolk that elicited symptoms, and serum specific IgEs for egg white (EW), egg yolk (EY) and ovomucoid were evaluated.

Of the 225 patients with FPIES, 140 fully met the diagnostic criteria whereas 79 patients did not fully meet them but demonstrated reproducible symptoms. The frequencies of pallor, lethargy, diarrhea, emergency room visits, and fluid therapy, which may reflect the severity of symptoms, were significantly higher in those who met the criteria fully, whereas the age at onset, trigger foods, comorbidity, and perinatal information were comparable. Analysis of patients with FPIES to hen’s egg revealed significantly higher levels of egg white- and egg yolk-specific IgE in patients who partly met criteria compared to those fully met criteria, whereas both groups had no IgE-mediated symptoms. In addition, the serving size eliciting symptoms was comparable between the groups. Patients who partly met the diagnostic criteria may have a milder phenotype of FPIES, but this needs to be validated in further studies using biomarkers reflecting the pathophysiology.

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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