Available online 27 April 2024

What is already known about this topic?

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. The symptoms may be severe, with profuse vomiting, lethargy and hypotension. Whether and when tolerance develops seems to vary among populations and trigger foods.

What does this article add to our knowledge?

This is the first study describing FPIES remission patterns in a large Scandinavian cohort. Oat-induced FPIES had a remission pattern similar to that of cow's milk-induced FPIES with early resolution. Fish-induced FPIES had a significantly poorer prognosis.

How does this study impact current management guidelines?

Given the favorable prognosis of cow’s milk- and oat-induced FPIES, we suggest that oral food challenges to these foods may be performed early in patients with a history of mild to moderate reactions.

Food protein-induced enterocolitis syndrome (FPIES), a non-immunoglobulin E (IgE)-mediated allergy, primarily affects infants and young children. Whether and when tolerance develops seems to vary among populations and trigger foods.

This study aimed to evaluate tolerance development and its assessment in a Swedish cohort.

This was a prospective follow-up study of a Swedish cohort of 113 children, followed at 25 pediatric departments, with acute FPIES. Data on oral food challenges and FPIES resolution was collected through chart reviews and, if incomplete, supplemental caregiver interviews.

The median age at last follow-up was 5.6 years (range 8.7 months to 16.5 years). Eighty-three children (73%) developed tolerance to 96 of 137 (70%) foods; 93% for cow’s milk, 92% for oat and 46% for fish. The median age when tolerance was developed was 36.0 months (IQR 23.7 to 48.2 months): 24.4 months for cow’s milk, 30.1 months for oat and 49.4 months for fish. Tolerance was determined in hospital in 45% of cases. Five percent demonstrated allergic sensitization to their FPIES trigger food. Age at tolerance development did not differ between sensitized and nonsensitized patients.

Most of the children in this Swedish cohort with FPIES achieved tolerance before age 4 years. Cow’s milk- and oat-induced FPIES had similar remission patterns, with early resolution. Development of tolerance to fish occurred significantly later compared with all other FPIES-inducing foods.

© 2024 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology