RT Journal Article
SR Electronic
T1 Food protein-induced enterocolitis syndrome in the British Isles
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP archdischild-2020-320924
DO 10.1136/archdischild-2020-320924
A1 Gary Stiefel
A1 Cherry Alviani
A1 Nadeem A Afzal
A1 Aideen Byrne
A1 George du Toit
A1 Audrey DunnGalvin
A1 Jonathan Hourihane
A1 Nicola Jay
A1 Louise Jane Michaelis
A1 Michel Erlewyn-Lajeunesse
YR 2021
UL http://adc.bmj.com/content/early/2021/08/25/archdischild-2020-320924.abstract
AB Background Food protein-induced enterocolitis syndrome (FPIES) is a delayed type of food allergy, most often seen in infancy. We aimed to estimate its incidence, to describe common food triggers and the patient journeys of this rare but serious condition.Design We undertook a prospective epidemiological survey of FPIES using the British Paediatric Surveillance Unit.Setting UK and Ireland.Participants A survey of all paediatricians over 13 months between January 2019 and February 2020.Main outcome measures 204 cases were reported, 98 (48%) meeting case definition, giving an incidence of 0.006% for England based on 93 cases.Results 98 patients reported 135 trigger foods, 27% (26 of 98) had multiple food triggers. Common food triggers included cow’s milk (24%, 33 of 135), fruits and vegetables (19%, 26 of 135), hen’s egg (16%, 22 of 135) and fish (14%, 19 of 135). In 46% (41 of 90), the initial trigger food had been ingested three or more times before diagnosis, with a median diagnostic delay of 7.9 months (3.0, 17.3). Half (50 of 98) were admitted, yet only 5% (5 of 98) received appropriate acute treatment with ondansetron. Most cases were diagnosed by an allergy specialist (74 of 98, 76%), within a median of 7.5 (3.0, 13.3) miles from home.Conclusion The incidence of FPIES was significantly lower than expected across the whole of the British Isles. Most reports were of cases local to specialist allergy centres, with delays in diagnosis. This suggests under-recognition of FPIES in frontline clinical setting where education of healthcare professionals is required to improve recognition, earlier diagnosis and treatment.No data are available.