Association of Antibiotic Usage With Food Protein-Induced Enterocolitis Syndrome Development From a Caregiver’s Survey

Food protein-induced enterocolitis syndrome (FPIES) is a frequently misdiagnosed, serious, non-IgE–mediated food allergy, and the precise mechanism of disease is unknown. Acute FPIES typically presents with repetitive, profuse vomiting approximately 1 to 4 hours post-ingestion of a food trigger. Chronic FPIES is considered less common and less well characterized. OBJECTIVE: We aimed to better describe FPIES and identify factors that may influence FPIES development through use of a self-reported, caregiver’s survey. METHODS: FPIES and allergy-free infant caregivers completed a survey regarding lifestyle factors that may influence allergy acquisition such as antibiotic usage and delivery mode. FPIES caregivers reported symptoms, number of food triggers, type of FPIES, and symptoms from breastmilk ingestion. FPIES infants were compared to allergy-free infants to identify factors potentially associated with FPIES. RESULTS: Infant and prenatal maternal antibiotic usage was higher in FPIES infants compared to allergy-free infants (43.8% versus 20.6% and 48.8% versus 23.57%, respectively; P < 0.05). When compared to infants with acute FPIES alone, infants described as both acute and chronic FPIES reported earlier onset of symptoms, more nonspecific symptoms, and symptoms triggered by breast milk, more antibiotic exposure, and more food triggers (P < 0.05). CONCLUSION: Antibiotic usage was significantly higher in FPIES infants when compared to allergy-free infants. Work is needed to elucidate the role of antibiotic usage in the etiology of FPIES. Infants reported to have both acute and chronic FPIES were significantly different from infants with acute FPIES alone, highlighting the need to more closely examine these different subtypes of FPIES.