Food protein-induced enterocolitis syndrome in the British Isles. Issue 2 (26th August 2021) - Stiefel, Gary
Abstract : Background: Food protein-induced enterocolitis syndrome (FPIES) is a delayed type of food allergy, most often seen in infancy. We aimed to estimate its incidence, to describe common food triggers and the patient journeys of this rare but serious condition. Design: We undertook a prospective epidemiological survey of FPIES using the British Paediatric Surveillance Unit. Setting: UK and Ireland. Participants: A survey of all paediatricians over 13 months between January 2019 and February 2020. Main outcome measures: 204 cases were reported, 98 (48%) meeting case definition, giving an incidence of 0.006% for England based on 93 cases. Results: 98 patients reported 135 trigger foods, 27% (26 of 98) had multiple food triggers. Common food triggers included cow's milk (24%, 33 of 135), fruits and vegetables (19%, 26 of 135), hen's egg (16%, 22 of 135) and fish (14%, 19 of 135). In 46% (41 of 90), the initial trigger food had been ingested three or more times before diagnosis, with a median diagnostic delay of 7.9 months (3.0, 17.3). Half (50 of 98) were admitted, yet only 5% (5 of 98) received appropriate acute treatment with ondansetron. Most cases were diagnosed by an allergy specialist (74 of 98, 76%), within a median of 7.5 (3.0, 13.3) miles from home. Conclusion: The incidence of FPIES was significantly lower than expected across the whole of the British Isles. Most reports were of cases local to specialist allergy centres, with delays in diagnosis. This suggests under-recognition of FPIES in frontline clinical setting where education of healthcare professionals is required to improve recognition, earlier diagnosis and treatment. Abstract : Using data obtained through the BPSU, Stiefel et al report the incidence of Food Protein-induced Enterocolitis Syndrome (FPIES) in 2019 in UK, and suggest there may be significant under-recognition of this type of food allergy.