Food protein-induced enterocolitis syndrome to nuts: An increasing phenomenon

Abstract

Food protein-induced enterocolitis syndrome (FPIES) is a non–immunoglobulin E (IgE)-mediated food allergy which typically presents in infancy. Although rice is a rare cause of IgE-mediated food allergy, it is one of the most common triggers of FPIES in Australia and the United States. 1 Mehr S. Frith K. Barnes E.H. Campbell D.E. FPIES Study GroupFood protein-induced enterocolitis syndrome in Australia: a population-based study, 2012-2014. J Allergy Clin Immunol. 2017; 140: 1323-1330 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar ,2 Ruffner M.A. Ruyman K. Bami S. Cianferoni A. Brown-Whitehorn T. Spergel J.M. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013; 1: 343-349 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Conversely, peanut and tree nuts are rarely described to cause FPIES, but are common triggers of IgE-mediated food reactions. Ruffner et al 2 Ruffner M.A. Ruyman K. Bami S. Cianferoni A. Brown-Whitehorn T. Spergel J.M. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013; 1: 343-349 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar reported peanut and tree nut FPIES in only 2% and less than 1% of children, respectively, in a retrospective cohort of 462 children from a single institution. Mehr et al 1 Mehr S. Frith K. Barnes E.H. Campbell D.E. FPIES Study GroupFood protein-induced enterocolitis syndrome in Australia: a population-based study, 2012-2014. J Allergy Clin Immunol. 2017; 140: 1323-1330 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar reported a single case (0.5%) of peanut FPIES in a prospective population-based study of 230 children. Case reports of peanut FPIES have been published, 3 Mansi J. Anvari S. Anagnostou A. Development of peanut allergy despite early introduction: a real-world case series in the United States. Pediatr Allergy Immunol. 2020; 31: 589-592 Crossref PubMed Scopus (2) Google Scholar , 4 Robbins K.A. Ackermann O.R. Carter C.A. Uygungil B. Sprunger A. Sharma H.P. Food protein-induced enterocolitis syndrome to peanut with early introduction: a clinical dilemma. J Allergy Clin Immunol Pract. 2018; 6: 664-666 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar and 1 case of peanut FPIES was noted as a reason for discontinuation in the Learning Early About Peanut (LEAP) allergy trial. 5 Du Toit G. Roberts G. Sayre P.H. et al. Randomised trial of peanut consumption in infants at rick of peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1129) Google Scholar We recently noted an increase in the number of children being referred with peanut FPIES to our private allergy services, in Melbourne, Australia.