Food protein induced enterocolitis syndrome in Australia: A population based study 2012-2014

Publication date: Available online 18 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sam Mehr, Katie Frith, Elizabeth H. Barnes, Dianne E. Campbell
BackgroundFood protein induced enterocolitis syndrome (FPIES) is a non-IgE mediated gastrointestinal allergic disorder. Large population based FPIES studies are lacking.ObjectiveTo determine the incidence and clinical characteristics of FPIES in Australian infantsMethodsAn Australia wide survey (2012-2014) was undertaken via the Australian Paediatric Surveillance Unit, with monthly notification of new cases of acute FPIES in infants aged <24 months by 1400 participating Paediatricians.Results230 infants with FPIES were identified. The incidence of FPIES in Australian infants (<24 months) was 15.4/100,000/year. Median age of first episode, diagnosis and notification were 5, 7 and 10 months respectively. There was no gender predilection. 7% of infants had siblings with a history of FPIES and 5% reacted during exclusive breastfeeding. 68% had a single food trigger (20% two, 12% three or more food triggers). The most common FPIES triggers were rice (45%), cow's milk (33%) and egg (12%). 51% of infants reacted on their first known exposure. Infants with FPIES to multiple versus single food groups were younger at initial episode (4.6 vs. 5.8 months, P=0.001) and more frequently had fruit and/or vegetable FPIES (66% vs. 21%, p<0.0001). Infants exclusively breastfed for more than 4 months had a trend to lower rates of FPIES to multiple food groups (23% vs. 36%, P=0.06). 64% of infants with multiple FPIES which included cow's milk FPIES had co-associated solid food FPIES. 42% of infants with fish-FPIES had reacted to other food groups.ConclusionsFPIES is not rare, with an estimated incidence of 15.4/100,000/year. Rice is the most common food trigger in Australia. Factors associated with multiple-FPIES included early onset disease and FPIES to fruits and/or vegetables.



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