Food Protein Induced Enterocolitis Syndrome (FPIES): Data from a Tertiary Care Center in Developing Country

Food Protein Induced Enterocolitis Syndrome (FPIES) is a non–IgE-mediated food allergy. In developing countries, FPIES may be under-recognized and misdiagnosed as gastrointestinal infection. We sought to characterize the clinical features of FPIES in a tertiary care center in Thailand. We collected data of the patients who were diagnosed as FPIES and prospectively followed at King Chulalongkorn Memorial Hospital between 2008-2018. Diagnosis of FPIES was confirmed based on clinical criteria and/or oral food challenge. Data regarding patient characteristics were collected. Twenty-six infants with FPIES were identified, 38 % were male. Median age of first episode was 4 months and median age of diagnosis was 7 months. The most common causative foods were cow’s milk (62%) and egg (15%), followed by soy (8%), fish (8%), banana (8%) and rice (4%). FPIES with multiple foods were identified in 4% of patients. Severe malnutrition occurred in 15 % of patients at presentation of which 50 % required intensive care unit admission due to complication of malnutrition and infection. All cases of severe malnutrition were due to chronic FPIES caused by cow’s milk. Tolerance developed in 46% of patients. The median age when tolerance was established was 4 years for cow’s milk , 2.5 years for egg and 2 years for banana. Our data pointed out the severity of FPIES and importance of recognition of this disorder in developing countries. Cow’s milk was the most common food trigger and was associated with more severe presentation and protracted course than other foods.