Food protein-induced enterocolitis syndrome caused by fish and/or shellfish in Italy.
BACKGROUND
The study describes the demographic features, culprit foods, clinical features and outcomes for children presenting with acute fish and/or shellfish food protein-induced enterocolitis syndrome (FPIES) in four Italian paediatric allergy centres.


METHODS
A retrospective/prospective study was undertaken. All children diagnosed with fish or shellfish FPIES were enrolled. The diagnosis of FPIES was based on Sicherer's or Miceli Sopo clinical criteria. Skin prick tests (SPT) were performed in all patients, at the time of diagnosis and prior to OFC.


RESULTS
Seventy children were enrolled. Mean age at first episode was 14 months (range 6-46 months); mean age at diagnosis was 34 months (range 6-164 months). Sole and cod were the fish most commonly implicated. Fifty-seven of 70 (81%) children had FPIES exclusively to fish, 37 of 57 (65%) children had single-fish FPIES, 20 of 57 (35%) multiple-fish FPIES, nine of 70 (13%) presented adverse reactions exclusively to shellfish, and four of 70 (6%) presented adverse reactions to both fish and shellfish. Only four (5.7%) children presented episodes of acute FPIES with different foods (2 to cow's milk, 1 to egg, 1 to beef); in all cases, onset was prior to that of fish or shellfish FPIES. Fifteen of 70 (21%) children tolerated fish other than the offending fish. Twenty-four of 70 (34%) children achieved tolerance (age range 24-102 months).


CONCLUSIONS
The chief peculiarities of acute fish and shellfish FPIES, compared to more frequent cow's milk or soy FPIES, are (i) later age of onset, (ii) longer persistence and (iii) possibility of tolerating fish other than the offending fish. Adverse reactions with shellfish are possible.
Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy.
Stefano
S
Miceli Sopo
Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy.
Serena
S
Monaco
Institute for Maternal and Child Health-IRCCS, Burlo Garofolo, Trieste, Italy.
Laura
L
Badina
Allergy Unit, Department of Pediatrics, A. Meyer Children's Hospital, University of Florence, Florence, Italy.
Simona
S
Barni
University of Trieste, Trieste, Italy.
Giorgio
G
Longo
Allergy Unit, Department of Pediatrics, A. Meyer Children's Hospital, University of Florence, Florence, Italy.
Elio
E
Novembre
Department of Paediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
Serena
S
Viola
Department of Paediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
Giovanna
G
Monti
D017668:Age of Onset; D000485:Allergens / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004760:Enterocolitis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005396:Fish Products; D005512:Food Hypersensitivity / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D007558:Italy; D008297:Male; D015995:Prevalence; D012758:Shellfish
D000485:Allergens
fish; food allergy; food protein-induced enterocolitis syndrome; shellfish