D1.64 - Severe Food Protein-Induced Enterocolitis Syndrome: A French Multicenter Study of Children Admitted to Critical Care

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. It can lead to severe reactions such as hypovolemic shock due to severe dehydration. Unidentified FPIES can lead to misdiagnosis and mismanagement, with potential life-threatening consequences. In this study, we describe the first series of severe FPIES hospitalized in the intensive care unit (ICU).

A restrospective study was conducted in seven tertiary referral hospitals in France between 2014 and 2024. 19 children were included. Datas from their ICU hospital stays were collected.

In all cases, cow's milk was the most likely responsible food (n=19). Prior to ICU admission, all had chronic digestive symptoms, including diarrhea (n=18), growth retardation (n=17), weight loss (n=14), vomiting (n=14) and food refusal (n=10). Median age was 3 months and median length of stay was 11 days. The clinical presentation included multi-visceral failure such as hemodynamic instability (n=19), respiratory distress (n=4), somnolence (n=11), weight loss greater than 10% (n=14), hypothermia (n=2).  Laboratory findings were metabolic acidosis (median pH 7.1) with methemoglobinemia (2.9-12.8). Management included fluid resuscitation (n=19) and fasting (median duration 4 days). 9 required total parenteral nutrition (median 17.5 days). 5 had a recurrence of FPIES on feeding resumption.

This is the largest cohort described in pediatrics. Prospective studies are needed to improve diagnostic recommendations and ICU management.