Food Protein-Induced Enterocolitis Syndrome in the US Population-Based Study

To estimate the lifetime prevalence of food protein-induced enterocolitis syndrome (FPIES) in the United States from a study designed to estimate the prevalence and distribution of IgE-mediated food allergies.

Study participants included adults (≥18 years) who were able to complete the survey in English or Spanish via web or telephone, who resided in a US household. METHODS. This was a cross-sectional, population based survey was administered to 53 575 US households. The outcome measure of interest was the answer to the question specifically asking if the respondent or his or her child ever had a physician diagnosis of FPIES.

There was a 51.2% completion rate of the survey. There was an overall estimated FPIES prevalence of 0.28% (95% confidence interval [CI] 0.24%–0.33%). Parents reported 261/38 408 children with FPIES for an estimated prevalence of 0.51% (95% CI: 0.42%–0.62%). As compared with children without FPIES, those with the condition were reported to have significantly more IgE-mediated food allergy (P < .001), asthma (P < .001), allergic rhinitis (P < .001), insect sting allergy (P = .007), latex allergy (P < .001), and urticaria (P < .001). There was a trend toward increased likelihood of atopic dermatitis and medication allergy (P = .06). Adults self-reported a FPIES prevalence of 0.22% (95% CI: 0.17%–0.28%). Adults reporting a history of FPIES were also more likely to have IgE-mediated food allergy and other atopic diseases.

These data suggest that FPIES has affected nearly 1 million Americans.

This study was the first to try to estimate the prevalence of FPIES in the United States. Although the survey asked about FPIES, it was not developed for that purpose. Definitions of the condition were not provided, nor were details about specific foods, symptoms, or how the diagnosis was made. Nonetheless, it provides important information for the clinician’s consideration. FPIES is not an uncommon condition. As has been reported elsewhere, it can be associated with IgE-mediated food allergies. Sometimes, the initial presentation is FPIES, and later, the child demonstrates evidence of mast cell activation after ingestion. FPIES can present with a spectrum of symptoms and symptom severity. Infants may become severely ill and appear toxic on presentation. The diagnosis can initially be elusive because these children are often thought to have septicemia with shock, severe viral gastroenteritis, or other conditions. However, it is imperative to consider FPIES, especially if the presentation repeats itself.