Evolution and Risk factor of failure of OFCs or prolonged FPIES
At the time of the last review of medical records, 151 out of 192 culprit foods were successfully reintroduced (78.6%). Eighty-eight percent of children with FPIES to CM were tolerant, as were 82.8% of those reactive to hen’s eggs, and 52.4% to fish (Table II). Among the tolerant patients, the overall age of tolerance was 2.2 years of age (1.7-3.0, n=150). Kaplan Meier curves showed an overall median survival of FPIES at 2.5 years of age, with a global resolution rate of 80.1% at 5 years of age (Figure 2). The resolution rate at 5 years of age was higher for FPIES to CM than to fish, and was similar for FPIES to CM and hen’s egg (Figure 3).
Performing a reintroduction within the 12 months after the onset of FPIES was associated with an increased risk of failure of an OFC (RR: 2.0 [1.2-3.5]), particularly in children with a severe form of FPIES (p<0.001).
Severe acute reactions increased the risk of persistent FPIES (RR: 3.3 [1.2-9.2]). Six patients with a history of severe reactions out of 13 (46.2%) were not tolerant after a median duration of up to 4.3 years of age. The 7 other patients were tolerant at 2.3 years of age.
IgE sensitization against the culprit food was not associated with a longer duration of FPIES among tolerant patients (p=0.3) and was not a risk factor of failure to an OFC (RR: 0.8 [0.3-2.0]).
Neither personal nor familial atopic history were risk factors of persistent FPIES (p=0.15 and 0.9 respectively).