Half Cow's Milk-Induced Food Protein Induced Enterocolitis Syndrome (FPIES) Require Amino Acid Feeding

Abstract

FPIES is mainly related to cow’s milk and manifests as a chronic digestive disease or in its acute form with potentially life-threatening vomiting/diarrhea/dehydration. The objective of this study is to characterize the clinical features of cow’s milk-induced FPIES in children. A cohort of patients with FPIES was constituted in French Children’s Hospitals (Necker, Paris – Lenval, Nice). Data were collected from medical records including all patients referred for an acute episode of FPIES, and divided into 2 groups according to their tolerance of extensively hydrolysed formula (eHF) or their need to be fed an amino-acid formula (AAF). 49 children were enrolled. Chronic had occurred in 36 (73%), after a median period of 10 days following introduction of milk-based formula. In the whole group, the acute episode occurred at a median age of 4 months. Allergy testing was rarely positive: patch test 21 (51%), skin prick tests 3 (8%), specific IgE 13 (30%). Recovery was observed in 19 (40%) at a median age of 31 months. The eHF group comprised 24 (49%) infants and the AAF one 25 (51%). They exhibited the following significant or trend towards significance differences : number of hospitalizations before diagnosis per patient 0,9 vs 2,7 (p=0,02), age of FA diagnosis 4,5 months vs 2,8 (p=0,04), food tolerance acquisition 54% vs 24% (p=0,02), associated FA 4% vs 48% (p=0,0002). Half infants with milk-induced FPIES do not tolerate eHF, and need to be fed with an AAF, a condition associated with a delayed diagnosis.