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 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
Status:	In Press
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/, Start Date: 2025-01-23
Publisher:	Elsevier
ISSN:	2213-2198
Date of First Compliant Deposit:	27 January 2025
Date of Acceptance:	14 January 2025
Last Modified:	27 Jan 2025 17:30
URI:	https://orca.cardiff.ac.uk/id/eprint/175647

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