The role of IgE sensitisation in acute FPIES: A systematic review and meta-analysis.

Abstract

Background: Evidence on the role of IgE sensitisation in acute Food Protein-Induced Enterocolitis Syndrome ('atypical FPIES') is limited. Initial reports claimed association with persistent disease, however recent studies have not replicated this.

Objective: To systematically review the relationship between sensitisation to the culprit food(s) in acute FPIES and the outcome of follow-up oral food challenges. To assess rates of sensitisation, seroconversion (i.e. switch from negative tests to sensitisation) and phenotype switch to IgE-mediated food allergy over time in individuals with acute FPIES.

Methods: Systematic review searching 10 databases. Studies of children and adults with acute FPIES diagnosis assessing IgE sensitisation to culprit food at onset or follow-up measured by skin prick or serological test were included.

Results: Of 1830 studies identified, 53 were eligible including 3514 participants. Ten studies had an analytical design assessing whether sensitisation was associated with disease persistence, with 4 showing an association and 6 showing no association. In individuals with acute FPIES, the sensitisation rate was 9.8% (95% CI: 7.4-12.1%; 34 studies, 2587 participants, I² = 82%); the frequency of seroconversion was 1.1% (95% CI: 0.1-2.1%; 9 studies, 673 participants, I²=32%); and phenotype switch occurred in 1.1% (95% CI: 0.4-1.7%; 14 studies, 935 participants, I² =0%) and 13% (95% CI: 5.5-20.5%, 12 studies, 93 participants; I²=18%) of sensitised participants.

Conclusion: We did not find consistent evidence for the relationship between IgE sensitisation and FPIES persistence. We found phenotype switch to IgE-mediated food allergy is uncommon in acute FPIES. IgE-sensitisation in FPIES does not have a clear relationship with clinical outcomes.