A Canadian study has provided new insights into food protein-induced enterocolitis syndrome (FPIES), a lesser-known form of food allergy that can be difficult to recognise because symptoms typically appear several hours after eating rather than within minutes.
Researchers followed 87 children aged between one month and 13 years who had been diagnosed with FPIES. The study found that symptoms most commonly began in infancy, with a median age of onset of seven months, and that most reactions occurred before the age of two.
Unlike conventional food allergies, FPIES does not usually cause hives, swelling or breathing difficulties. Instead, it triggers inflammation in the intestine, leading to severe vomiting, lethargy and dehydration one to four hours after consuming a trigger food. Because the symptoms can resemble gastroenteritis, diagnosis is often delayed.
The study identified egg as the most common trigger, accounting for 27.6% of reactions, followed by seafood (21%), milk (11.2%), fish (10.3%), peanut (10.3%), oats (7%), fruit (6.2%) and soy (3.1%). Approximately 9% of children reacted to more than one food.
Researchers also found that 42% of participants had eczema or atopic dermatitis, while 20.4% had other food allergies and 14% had asthma. However, more than one-third had no other associated allergic conditions.
More than 80% of children in the study developed tolerance to their trigger food and became symptom-free in the years following diagnosis, with FPIES often resolving before school age.
Reference: Angela Mulé et al, Food Protein-Induced Enterocolitis Syndrome among Canadian Children Living in Montreal, International Archives of Allergy and Immunology 2026. DOI: 10.1159/000552386.
Additional reporting: Medical Xpress
