title: Food protein-induced enterocolitis syndrome: insights from review of a large referral population.
abstract: BACKGROUND
  Food protein-induced enterocolitis (FPIES) is a rare non-IgE mediated disease. Most studies have been limited in nature, with the largest cohort being 66 patients. The most common foods that have been reported are milk and soy.
  
  
  OBJECTIVE
  A retrospective chart review of patients seen in the Allergy Section at The Children's Hospital of Philadelphia with International Classification of Diseases Ninth Revision code of 558.3 (Allergic Gastroenteritis and Colitis) between 2007 and 2012 was conducted to identify patients with suspected FPIES. Diagnosis of FPIES was confirmed based on meeting clinical criteria of delayed reaction with pronounced vomiting and/or diarrhea. Data regarding patient characteristics and features of their reactions were collected for analysis and comparison with existing studies.
  
  
  RESULTS
  A total of 462 cases were identified in our chart review. Patients had a similar demographic profile to the normal allergy patients seen in our clinic. The most common foods identified were milk (67%), soy (41%), rice (19%), oat (16%), and egg (11%). Patients had onset of FPIES to milk and soy around 7 months of age compared with 12 months of age for solid foods. FPIES reactions were identified to meats, tree nuts, peanuts, fruits, and vegetables; 70% of the patients reacted to one or two foods. Skin prick testing and atopy patch testing were not helpful in identifying the foods.
  
  
  CONCLUSIONS
  FPIES reactions were seen more frequently than previously described. However, the presentation and clinical features were similar to previous reports. Milk- and soy-triggered FPIES were common, and 43.5% of patients who had a milk trigger reacted to soy. There is no laboratory test to identify foods that cause FPIES, and clinician-supervised oral food challenge is the only definitive test available.
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Ruffner
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ruymann
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa; Allergy and Clinical Immunology Unit, Pediatric, A. Meyer Children's Hospital, Florence, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Barni
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cianferoni
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Terri
authors.initials: T
authors.lastname: Brown-Whitehorn
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: spergel@email.chop.edu.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
mesh_terms: D017668:Age of Onset; D002675:Child, Preschool; D004044:Dietary Proteins / Q000009:adverse effects*; D004760:Enterocolitis / Q000175:diagnosis*; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D013577:Syndrome
chemical_list: D004044:Dietary Proteins
keywords: Diarrhea; FPIES; Food Allergy; Food protein–induced enterocolitis syndrome; Vomiting