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

Phelan, A., Infante, S., Barni, S., Nurmatov, U. ORCID: https://orcid.org/0000-0002-9557-8635, Boyle, Rj and Vazquez-Ortiz, M. 2025. The role of IgE sensitisation in acute FPIES: A systematic review and meta-analysis. Journal of Allergy and Clinical Immunology: In Practice 13 (4) , pp. 861-884. 10.1016/j.jaip.2025.01.016

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Elsevier
ISSN:	2213-2198
Date of First Compliant Deposit:	27 January 2025
Date of Acceptance:	14 January 2025
Last Modified:	16 Apr 2025 10:16
URI:	https://orca.cardiff.ac.uk/id/eprint/175647

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