D1.177 - FPIES in fish in children: Study of the natural history of the disease

Food protein induced enterocolitis in fish (FPIES) is a non-IgE mediated food allergy that includes multiple episodes of vomiting 1 to 4 hours after the consumption of the culprit food. It constitutes a frequent food allergy in children with a high prevalence in the Mediterranean countries.

We retrospectively studied 94 children (48 boys) aged 2 to 18 years, that referred to our pediatric allergy clinic due to non-IgE mediated symptoms correlated with fish ingestion. Data on the age of resolution, personal and family atopic history, birth age, and history of breastfeeding were recorded. An Oral Food Challenge was also performed in 18 patients on the hospital grounds. 

66 (70,2%) children (33 boys) managed to tolerate fish at a mean age of 5 (+1) years. 28 (29,8%) remained in an exclusion diet with 22 of them refusing an oral food challenge due to the unpleasant experience of vomiting. 4 performed an oral food challenge at home despite the practitioners’ instructions with a positive outcome. Overall, 18 patients performed an oral food challenge with cod on the hospital grounds with a negative in 16 of them (88 %). The patients that performed the oral food challenge had a mean age of 8,3 (+ 2) years and the mean quantity that they consumed was 52 grams of fish, thus 9,3 grams of fish protein.

The majority of children with FPIES in fish manage to tolerate fish approximately at the age of 5 years. The reluctance to perform an oral food challenge leads to maybe needless exclusion diets. In the oral food challenge children can tolerate an age-appropriate portion of fish with no major problems.