Association between Eosinophilic Esophagitis and Food Protein-Induced Enterocolitis Syndrome in Children

Background: The prevalence of food allergy in the pediatric population is increasing. Classic IgE-mediated allergies have been well studied. However, less is known about non-IgE-mediated allergies. Eosinophilic Esophagitis (EoE), a mixed IgE and non-IgE-mediated allergy, and Food Protein-Induced Enterocolitis Syndrome (FPIES), a non-IgE-mediated allergy, have similar symptoms but different ages of presentation (any age vs.age; respectively). The purpose of this study is to determine the odds of developing EoE in children previously diagnosed with FPIES or who exhibited symptoms characteristic of FPIES. Methods: Analysis of retrospectively reviewed medical record data included demographic, clinical, and nutrition characteristics as well as history of gastrointestinal symptoms, diagnosis of EoE, and diagnosis or symptoms of FPIES (history of vomiting) in a large cohort of children receiving care at an urban pediatric gastroenterology clinic. Nutrition characteristics included infant feeding regimen (breast fed vs. formula fed) and age of complementary food introduction. The population sample was provided by the GI Care for Kids Clinical Dietitian. Medical records were reviewed for all patients diagnosed with FPIES between March 1, 2016 and May 30, 2018 and an equivalent number of patients diagnosed with EoE in the same time frame. Results: The majority of the population (N=148) was male (57.4%) and Caucasian (97.7%). The odds of developing EoE (mean age 9.3 + 5.4 years) by prior diagnosis of FPIES (median age 0.83 [Interquartile range; 0.6, 1.2]) or symptoms of FPIES was 0 and 0.25 (95% Confidence Interval; 0.109, -0.575), respectively. Logistic regression analysis revealed that gender, previous history of food allergy and intolerance, and history of vomiting explain 23% to 31% of the variation in EoE diagnosis. Conclusions: A history of symptoms characteristic of FPIES reported in the first year of life were observed to be protective for the development of EoE during childhood. The treatment for FPIES or its symptoms includes the elimination of common food allergens. Additional studies are needed to evaluate the effect of early infant diet on the future development of EoE