Food Protein-Induced Enterocolitis Syndrome: 16-Year Experience

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. This was a retrospective study of children with food protein-induced enterocolitis syndrome who presen...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2009-03, Vol.123 (3), p.e459-e464
Main Authors: Mehr, Sam, Kakakios, Alyson, Frith, Katie, Kemp, Andrew S
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Children & youth
Diagnosis, Differential
Diarrhea
Dietary Proteins - adverse effects
Enterocolitis - diagnosis
Enterocolitis - diet therapy
Failure to Thrive - etiology
Female
Food Hypersensitivity - diagnosis
Food Hypersensitivity - diet therapy
Humans
Immunoglobulin E - blood
Intradermal Tests
Male
Meat - adverse effects
Medical diagnosis
Milk Proteins - adverse effects
Oryza - adverse effects
Pediatrics
Proteins
Recurrence
Retrospective Studies
Risk Factors
Soybean Proteins - adverse effects
Vomiting
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Summary: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. 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. 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 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. 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.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2008-2029