Clinical Significance of Egg Sensitization in Pediatric Food Protein-Induced Enterocolitis Syndrome to Hen's Egg
Abstract
Background: Hen's egg, a common IgE-mediated food allergen, is an increasingly common food protein-induced enterocolitis syndrome (FPIES) trigger. Atypical FPIES is defined as detectable IgE to the food causing FPIES.
Objective: To evaluate clinical characteristics, natural history, baked egg tolerance, and FPIES challenge outcomes based on allergic sensitization status in patients with egg FPIES.
Methods: This retrospective, dual-center cohort study examined children with the diagnosis of egg FPIES by an allergist. We reviewed charts for reaction characteristics, atopic history, allergic sensitization to egg, baked egg tolerance, and food reintroduction outcomes.
Results: Of 153 patients with FPIES, 124 underwent egg allergy testing and 56 (36.6%) were sensitized to egg. Skin testing and food reintroduction varied based on practice and patient preferences. Of 48 patients who introduced baked egg, 30 (62.5%) tolerated it after a median of 20.5 months (interquartile range, 13.25-33 months) of avoidance. Including those tolerating baked egg at presentation, 22.9% incorporated baked before unbaked egg. Sensitization did not delay tolerance but was linked to a higher risk of immediate hypersensitivity during reintroduction. IgE-mediated symptoms were evident during reintroductions in sensitized patients but were absent in non-sensitized and untested patients. The overall phenotype switch rate from FPIES to IgE food allergy was at least 9.2%. Concomitant IgE-mediated food allergy…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 153 participants or records.
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