3 Cases of Peanut-Related Food Protein-Induced Enterocolitis Syndrome; Will Early Introduction Lead to More?

Background
Early dietary introduction of peanut has been shown to reduce the frequency of development of peanut allergy in high risk infants. Families have been recommended to add peanut to the diet early in life. While peanut has not been reported as a common trigger of food protein-induced enterocolitis syndrome (FPIES), it is possible that earlier introduction could lead to an increase in peanut-related FPIES (prFPIES). We report 3 cases of prFPIES seen before 8 months of age.

Methods
Retrospective chart review of 3 patients with dietary peanut introduction before 8 months of age, diagnosed with prFPIES.

Results
Case 1: 5-month-old male, who developed repetitive vomiting 2-3 hours after his second and third peanut ingestions, with positive SPT for peanut (6mm). Case 2: 6-month-old female who, on day 2 of peanut introduction, started vomiting 90 minutes after ingestion. Skin prick test (SPT) was negative to peanut. Case 3: 7-month-old female who became pale, lethargic, and vomited two hours after peanut introduction. SPT and serum immunoglobulin E were negative. A peanut oral food challenge (OFC) was scheduled (it was unclear if the trigger was peanut butter or the wheat bread it was spread on), and 2 hours after peanut intake she started vomiting.

Conclusions
Although prFPIES has been described, peanut is not a common trigger of FPIES. These 3 cases of prFPIES in our practice raise the question of whether early dietary peanut introduction will increase the incidence of prFPIES.