The first Canadian study of food protein-induced enterocolitis syndrome (FPIES) is helping clinicians better recognize a little-known condition that can send infants and young children to the emergency department with severe vomiting and dehydration.
A few hours after eating, an infant may suddenly experience a severe reaction that leaves his or her parents searching for answers. Such episodes may be caused by food protein-induced enterocolitis syndrome (FPIES), a condition that is often mistaken for other health problems and frequently goes undiagnosed.
A new study conducted by researchers at the Research Institute of the McGill University Health Centre (The Institute) describes the symptoms and triggers associated with this syndrome, as well as its progression in 87 children aged one month to 13 years who were followed at the Montreal Children's Hospital and an affiliated clinic. Published in the journal International Archives of Allergy and Immunology, this study is the first Canadian cohort study dedicated to FPIES.
"FPIES is an immune reaction that causes inflammation of the intestine and can lead to severe vomiting, severe fatigue and dehydration within a few hours of ingesting certain foods," explains Dr. Moshe Ben-Shoshan, the study's lead author, a pediatric allergist and immunologist at the Montreal Children's Hospital (MCH) and a scientist with The Institute's Infectious Diseases and Immunity in Global Health Program. "An acute episode can be extremely distressing for parents. Without a clear diagnosis, many families make repeated visits to the emergency room before getting answers."
Symptoms that can be confusing
FPIES differs from classic food allergies in that it does not involve the antibodies responsible for allergic reactions that occur within minutes of ingesting the allergen. It generally does not cause hives, swelling, breathing difficulties or anaphylactic shock.
According to researchers, symptoms typically appear one to four hours after ingesting the trigger food and often resemble those of gastroenteritis, which can complicate clinical detection. When this syndrome goes unrecognized, children may be subjected to unnecessary dietary restrictions and face an increased risk of nutritional deficiencies at a critical stage of their growth and development.
The researchers observed that the median age of symptom onset was seven months and that the majority of reactions occurred before the age of two.
Although almost any food can trigger a reaction, the main foods associated with reactions in the cohort were eggs (27.6%), seafood (21%), milk (11.2%), fish (10.3%), peanuts (10.3%), oats (7%), fruit (6.2%) and soy (3.1%). About 9 per cent of the children had reactions to more than one food.
Nearly 42 per cent of the children also had eczema or atopic dermatitis, while 20.4% suffered from other food allergies and 14 per cent suffered from asthma. However, more than a third of the participants (36.6%) had no other associated conditions.
"One of the most encouraging findings of our study is that the majority of children develop a tolerance to their trigger food over time and that the condition often resolves before they reach school age," explains Angela Mulé, the study's first author and an undergraduate student at McGill University. In fact, more than 80 per cent of the children in the study no longer had symptoms in the years following their diagnosis.
"The results of this study highlight the importance of raising awareness of FPIES among family physicians, pediatricians, emergency physicians and other primary care providers, who are often the first to evaluate these children," says Dr. Ben-Shoshan. "Early diagnosis allows us to provide families with the tools and support they need to manage the condition with confidence."
The research team plans to expand the study to other Canadian provinces in order to compare food triggers, management practices, and the progression of FPIES across the country. The researchers also hope to better understand the differences between FPIES in children and adults.
Funding
The project received a student research grant from the Canadian Society of Allergy and Clinical Immunology (CSACI), awarded to Angela Mulé.
About the Study
The article Food Protein-Induced Enterocolitis Syndrome (FPIES) among Canadian children living in Montreal by Angela Mulé, Pasquale Mulé, Adnan Al Ali, Catherine Prattico, Xun Zhang, Christine McCusker, Vicky Le Blanc, and Moshe Ben-Shoshan was published in International Archives of Allergy and Immunology.
DOI : 10.1159/000552386
