Food protein induced enterocolitis syndrome (FPIES)
This BPSU study investigates food protein induced enterocolitis syndrome (FPIES), a rare delayed type of food allergy which leads to repeated vomiting and other gastrointestinal symptoms up to several hours after a problem food (or baby formula) is eaten. There is very limited data on FPIES in the UK and this study is intended to improve our knowledge of the incidence, clinical presentation and management as well as improve awareness amongst paediatricians. This has the potential to benefit patients and families through quicker diagnosis and instigation of effective management of FPIES. A paper has now been published in the Archives of disease in childhood.
Overview
FPIES is a rare but serious form of food allergy. It manifests in infancy as repetitive vomiting, diarrhoea and a systemic inflammatory response. In some children it may progress to dehydration and shock. It was first described about 30 years ago in the United States. Over the last decade increasing numbers of cases are being recognised by paediatricians in the UK. However, the condition is under recognised which can lead to misdiagnosis and delay in treatment. The most common foods causing FPIES are cow’s milk, soya and rice although many other causative foods have been described. Diagnosis is predominantly clinical, and management involves dietary exclusion and symptomatic treatment in cases of accidental ingestion.
There is very limited available data regarding the incidence and prognosis of this condition, and none from the UK. A single study in Israel showed a cumulative incidence of 0.34% of milk FPIES. Our clinical experience suggests that the UK incidence of this rare but important condition is much lower, but this may be due to under recognition by UK paediatricians. The Australian PSU has recently completed an FPIES survey and have recently published. They reported 230 cases in 29 months with an incidence of 15.4/100,000/year.
Investigators
Dr Gary Stiefel
Respiratory Office, Ward 28, Level 4, Windsor Building
Leicester Royal Infirmary
Infirmary Square
Leicester LE1 5WW
Email: / gary.ghs.stiefel@nhs.net
Dr Mich Erlewyn-Lajeunesse
Southampton General Hospital
Tremona Road
Southampton SO16 6YD
Published papers
Stiefel G, Alviani C, Afzal NA, Byrne A, du Toit G, DunnGalvin A, et al. Food protein-induced enterocolitis syndrome in the British Isles. Arch Dis Child. 2022;107(2):123–127. doi:10.1136/archdischild-2020-320924.
Duration
January 2019 – January 2020