Food Protein-Induced Enterocolitis Syndrome: Data from a Multicenter Retrospective Study in Spain

Objective: To describe clinical, epidemiological and management characteristics of food protein-induced enterocolitis syndrome (FPIES) cases in Spain. Patients and methods: Multicenter observational retrospective study. FPIES cases diagnosed in specialized units in Spain over 12 months in 2017 (January to December) according to the recently published international diagnostic criteria were included. Results: One hundred and twenty patients (53.3% males) were included. The majority were acute (111) with mild to moderate severity (76.7%). Triggering foods were cow's milk (48/120), fish (38), egg (13), rice (12), and soy (1). The majority (84.2%) of the patients had FPIES to one food only. In addition to vomiting (100%), pallor (89.2%) and altered behavior (88.3%) were most frequently observed in acute forms. On the contrary, diarrhea (70%), abdominal distension (33.3%) and blood in stools (44.4%) were more frequently observed in chronic cases. Oral challenge was performed in 18.9% of the acute forms compared to 44.4% of the chronic forms. The most common treatment was intravenous fluids followed by ondansetron. Corticosteroids were used in 6 patients (5 with acute symptoms and 1 chronic). Seven patients were treated with antibiotics for suspicion of infection. Most cases of cow's milk FPIES were treated with extensively hydrolyzed formulas (69.8%). Conclusions: FPIES is not uncommon in our units. Unlike other published series, fish and egg are important triggers in our country. A greater knowledge and diffusion of the international consensus criteria will allow a better characterization of the cases and a standardization of their management. Address correspondence and reprint requests to Juan J. Díaz, MD, PhD, Hospital Universitario Central de Asturias, Oviedo. Avda. de Roma s/n 3301 Oviedo, Asturias, Spain (e-mail: Juanjo.diazmartin@gmail.com). Received 12 August, 2018 Accepted 1 October, 2018 Financial Disclosure: The authors have no financial relationships relevant to this article to disclose Funding source: The project was done with no specific support Conflicts of Interest Statement for all authors Dr Díaz have received received payment for lectures or travels from Alter, Danone-Nutricia, Hero, Mead Johnson, Nestlé, Ordesa; have participaed in scientific advisory Board for Danone-Nutricia and received payment for educational materials from Mead-Johnson Dr Espin have received payment for lectures or travels from Alter, Danone-Nutricia, Ferrer, Hero, Lactalis, Mead Johnson, Nestlé, Ordesa; have participaed in scientific advisory Board for Danone-Nutricia; received funding for research from: Alter, Hero, Lactalis, Ordesa; and received payment for educational materials from Alter, Danone-Nutricia, Mead-Johnson. Dr Segarra has served as a speaker, a consultant and advisory member for or has received research or education funding from MSD, Abbvie, Pfizer, Ferring, Shire Pharmaceuticals, Nutricia, Nestlé, Abbott, Mead Johnson. Dr Domínguez-Ortega has served as a speaker, a consultant and advisory member for or has received research or education funding from Nutricia, Nestlé and Mead Johnson Dr Blasco-Alonso have received speaker fees from Nestlé and Danone-Nutricia Dr Moreno have received speaker fees from Hero Dr. Rayo and Fernandez have no potential conflict of interest to disclose © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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