title: Food protein-induced enterocolitis syndrome: 16-year experience.
abstract: OBJECTIVE
  The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced enterocolitis syndrome.
  
  
  METHODS
  This was a retrospective study of children with food protein-induced enterocolitis syndrome who presented to the Children's Hospital at Westmead (Sydney, Australia) over 16 years.
  
  
  RESULTS
  Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of <36 degrees C at presentation was recorded for 24% of episodes. A platelet count of >500 x 10(9) cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age.
  
  
  CONCLUSIONS
  Misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome.
authors.affiliation: Department of Allergy and Immunology, Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales, Australia 2145. samm@chw.edu.au
authors.forename: Sam
authors.initials: S
authors.lastname: Mehr
authors.forename: Alyson
authors.initials: A
authors.lastname: Kakakios
authors.forename: Katie
authors.initials: K
authors.lastname: Frith
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Kemp
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004044:Dietary Proteins / Q000009:adverse effects*; D004760:Enterocolitis / Q000175:diagnosis* / Q000178:diet therapy; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000178:diet therapy; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007428:Intradermal Tests; D008297:Male; D008460:Meat / Q000009:adverse effects; D008894:Milk Proteins / Q000009:adverse effects; D012275:Oryza / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D030262:Soybean Proteins / Q000009:adverse effects
chemical_list: D004044:Dietary Proteins; D008894:Milk Proteins; D030262:Soybean Proteins; D007073:Immunoglobulin E