Food aversion and poor weight gain in food protein–induced enterocolitis syndrome: A retrospective study

• Published in: Journal of allergy and clinical immunology 2020-05, Vol.145 (5), p.1430-1437.e11
• Main Authors: Su, Kuan-Wen, Patil, Sarita U., Stockbridge, Jennifer L., Martin, Victoria M., Virkud, Yamini V., Huang, Jing-Long, Shreffler, Wayne G., Yuan, Qian
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Boston; Child; Child, Preschool; Dietary Proteins - adverse effects; Enterocolitis - etiology; Feeding and Eating Disorders - etiology; Female; food aversion; Food Hypersensitivity - etiology; Food protein–induced enterocolitis syndrome; Humans; Infant; Male; Middle Aged; poor body weight gain; Retrospective Studies; Risk Factors; Syndrome; Tertiary Care Centers; Weight Gain; Young Adult
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2020.01.001

Food protein–induced enterocolitis syndrome (FPIES) is a form of non–IgE-mediated gastrointestinal food allergy. Insufficient data exist in regard to gastrointestinal history and outcome, particularly comorbidity, family history, food aversion, and poor body weight gain. We sought to identify the gastrointestinal outcomes and related risk factors in FPIES. We analyzed the clinical features and gastrointestinal outcomes of patients with FPIES retrospectively at 4 hospitals in Boston. Two hundred three patients with FPIES were identified, including 180 only with acute FPIES, 8 with chronic FPIES, and 15 with both. Oat (34.5%), rice (29.6%), and cow’s milk (19.2%) were the most common food triggers. The prevalence rates of personal history with allergic proctocolitis (23.2%) and family history with inflammatory bowel diseases (9.4%) and celiac disease (7.3%) were higher than those in the general population. Compared with patients with FPIES with 1 or 2 food triggers, the risk of developing food aversion increased in cases triggered by 3 or more foods (adjusted odds ratio, 3.07; 95% CI, 1.38-6.82; P = .006). The risk of poor body weight gain increased in FPIES triggered by cow’s milk (adjusted odds ratio, 3.41; 95% CI, 1.21-9.63; P = .02) and banana (adjusted odds ratio, 7.63; 95% CI, 2.10-27.80; P = .002). Gastrointestinal comorbidities and family history were common in patients with FPIES. Patients with FPIES with 3 or more triggers were at risk of food aversion. Patients with FPIES with cow’s milk and banana as triggers were at risk of poor body weight gain.