A Second Slice of FPIES: A Single Center Reappraisal of Pediatric FPIES

BACKGROUND

Food protein-induced enterocolitis syndrome (FPIES) is being increasingly recognized as a non-IgE mediated food allergy; however, it remains unclear if and how the presentation, diagnosis and management of this disease has changed in recent years.

OBJECTIVE

To reappraise the FPIES cohort at a large United States pediatric tertiary referral center.

METHODS

We performed a retrospective chart review of pediatric FPIES patients (ICD-10: K52.21) diagnosed in our allergy/immunology clinics between 2018-2022.

RESULTS

There were 210 children diagnosed with FPIES. Most were White (73.8%), non-Hispanic (71.4%) and male (54.3%) with private insurance (77.6%). Cow's milk was the most common food trigger (35.2%) with the earliest median age of onset of 5 months. The atypical FPIES rate was 13.8%. FPIES was accurately diagnosed in 54.3% at the first medical contact. The oral food challenge pass rate was 73.5%. The rate of trigger resolution at 36 months was 77%.

CONCLUSION

By comparing trends from a previous and current FPIES cohort, we were able to assess the potential impact of various guidelines and practice changes on the diagnosis and management of FPIES at our center. Milk and oat surpassed rice as the most common FPIES triggers; peanut and egg emerged as new FPIES triggers; there was a shorter time to diagnosis and an increased rate of atypical FPIES. Our findings reflect earlier recognition of FPIES and prompt allergy/immunology referral from community physicians, implementation of recent medical society guidelines for infant feeding practices and growing clinical expertise of allergists at our center.

Distinct Food Triggers for Migraine, Medication Overuse Headache and Irritable Bowel Syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is an under-diagnosed common health problem that impairs quality of life. Migraine and IBS are comorbid disorders that are triggered by foods. We aim to investigate IBS frequency in medication overuse headache (MOH) patients and identify food triggers and food avoidance behavior.

METHODS

Participants who completed the cross-sectional, observational and online survey were included (n = 1118). Demographic data, comorbid disorders, medications used, presence of headache, the diagnostic features of headache and IBS, migraine related subjective cognitive symptoms scale (MigSCog), consumption behavior of patients regarding 125 food/food additives and food triggers were asked about in the questionnaire.

RESULTS

Migraine and MOH diagnoses were made in 88% and 30.7% of the participants, respectively. Non-steroidal anti-inflammatory drugs (NSAIDs) were the main overused drug (89%) in MOH patients. IBS symptoms were present in 35.8% of non-headache sufferers, 52% of migraine patients and 65% of MOH patients. Specific food triggers for MOH patients were dopaminergic and frequently consumed as healthy foods such as banana, apple, cherry, apricot, watermelon, olive, ice cream and yogurt. MigSCog scores were significantly higher in episodic migraine and MOH patients when IBS symptoms coexisted.

CONCLUSIONS

The frequency of IBS was higher in MOH patients compared to migraine patients. Coexistence of IBS seems to be a confounding factor for cognitive functions. MOH specific triggers were mostly dopaminergic foods, whereas migraine specific food triggers were mostly histaminergic and processed foods. Personalized diets focusing on food triggers and interference with leaky gut must be integrated to MOH and migraine treatment to achieve sustainable management of these disorders.