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

https://doi.org/10.1016/j.jaci.2020.01.001Get rights and content

Background

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.

Objective

We sought to identify the gastrointestinal outcomes and related risk factors in FPIES.

Methods

We analyzed the clinical features and gastrointestinal outcomes of patients with FPIES retrospectively at 4 hospitals in Boston.

Results

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).

Conclusions

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.

Section snippets

Study design

We retrospectively reviewed FPIES cases in 2 tertiary hospitals (Massachusetts General Hospital and Brigham and Women’s Hospital) and 2 community hospitals (North Shore Medical Center and Newton-Wellesley Hospital) in the Boston-based Partners HealthCare system. Patients with FPIES were identified through the Research Patient Data Registry, using the International Classification of Diseases, Tenth Revision code K52.21 (food protein–induced enterocolitis syndrome), as well as an electronic

Subjects’ characteristics

From 5,112,203 electronic medical records, we identified 875 unique records on the initial query of the Research Patient Data Registry system. From these, we identified 203 FPIES cases. The remaining records were excluded from analysis because they were falsely matched or compatible with other diseases. Two hundred one (99.0%) patients were seen at least once at Massachusetts General Hospital, 83 (40.9%) at Newton-Wellesley Hospital, 63 (31.0%) at Brigham and Women’s Hospital, and 24 (11.8%) at

Discussion

It has long been speculated that more food triggers and longer duration of symptoms of FPIES would potentially impose a negative impact on patients’ life.8 In this study, we provide direct evidence that FPIES triggered by multiple foods (≥3) is a risk factor for developing food aversion. Furthermore, with the addition of each individual trigger to patients affected by FPIES, the risk of developing food aversion increased by 1.65 times. This association is similar to the previous findings that

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This study was supported by the Demarest Lloyd Jr Foundation (grant no. 230465) and the Food Allergy Science Initiative (grant no. 229711). K.W.S. was supported by grants from Chang Gung Memorial Hospital and from the Ministry of Science and Technology, Taiwan (grant no. 107-2917-I-182-001). S.U.P. and Y.V.V. were supported by the National Institutes of Health, National Institute of Allergy and Infectious Diseases (grant no. K23AI121491 to S.U.P. and grant no. K23AI130408 to Y.V.V.).

Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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