Food aversion and poor weight gain in food protein-induced enterocolitis syndrome: A retrospective study

J Allergy Clin Immunol. 2020 May;145(5):1430-1437.e11. doi: 10.1016/j.jaci.2020.01.001. Epub 2020 Jan 12.


Background: Food protein-induced enterocolitis syndrome (FPIES) is a form of non-IgE-mediated gastrointestinal food allergy. Insufficient data exist in regard to gastrointestinal history and outcome, particularly comorbidity, family history, food aversion, and poor body weight gain.

Objective: We sought to identify the gastrointestinal outcomes and related risk factors in FPIES.

Methods: We analyzed the clinical features and gastrointestinal outcomes of patients with FPIES retrospectively at 4 hospitals in Boston.

Results: Two hundred three patients with FPIES were identified, including 180 only with acute FPIES, 8 with chronic FPIES, and 15 with both. Oat (34.5%), rice (29.6%), and cow's milk (19.2%) were the most common food triggers. The prevalence rates of personal history with allergic proctocolitis (23.2%) and family history with inflammatory bowel diseases (9.4%) and celiac disease (7.3%) were higher than those in the general population. Compared with patients with FPIES with 1 or 2 food triggers, the risk of developing food aversion increased in cases triggered by 3 or more foods (adjusted odds ratio, 3.07; 95% CI, 1.38-6.82; P = .006). The risk of poor body weight gain increased in FPIES triggered by cow's milk (adjusted odds ratio, 3.41; 95% CI, 1.21-9.63; P = .02) and banana (adjusted odds ratio, 7.63; 95% CI, 2.10-27.80; P = .002).

Conclusions: Gastrointestinal comorbidities and family history were common in patients with FPIES. Patients with FPIES with 3 or more triggers were at risk of food aversion. Patients with FPIES with cow's milk and banana as triggers were at risk of poor body weight gain.

Keywords: Food protein–induced enterocolitis syndrome; food aversion; poor body weight gain.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Boston
  • Child
  • Child, Preschool
  • Dietary Proteins / adverse effects*
  • Enterocolitis / etiology*
  • Feeding and Eating Disorders / etiology*
  • Female
  • Food Hypersensitivity / etiology*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Syndrome
  • Tertiary Care Centers
  • Weight Gain
  • Young Adult


  • Dietary Proteins