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New trends in pediatric FPIES: evolving triggers and improved management

Published: April 27, 2024

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a delayed gastrointestinal food allergic reaction that can affect patients across all age spectrums. Recent shifts in pediatric dietary guidelines and the publication of the 2017 International FPIES Guidelines could impact the presentation and management of FPIES.

In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Haddad and colleagues examined a cohort of 210 pediatric patients with FPIES at the largest pediatric hospital in the U.S. between 2018 to 2022. The study was a retrospective analysis of medical records comparing the recent cohort against earlier data (2015-2017) from an FPIES cohort. The study aimed to examine changes in the allergens triggering FPIES, the age of FPIES onset, diagnostic and resolution timelines, and management of the condition. Furthermore, the study sought to measure the impact of the 2017 International FPIES Guidelines and updated infant feeding guidelines and observe for any changes in clinical practice and patient outcomes.

The research identified notable shifts in FPIES triggers—cow's milk had become the most common FPIES trigger, surpassing rice. Egg and peanut were recognized as new FPIES triggers, which had not been previously seen in the earlier cohort. The study also revealed significant improvements in clinical practice, including earlier and more accurate diagnoses, and a slightly improved FPIES resolution rate by 36 months of age. Additionally, the study provided more evidence for atypical FPIES to different food triggers. Overall, the improved advancements were attributed to enhanced awareness among healthcare providers and adherence to updated feeding guidelines that recommend the early introduction of potential allergens, such as peanut and egg.

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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