Hospital-based Introduction of Untested High-risk Foods for Down Syndrome Infant with Severe Food Protein-induced Enterocolitis Syndrome: A Case Report

TL;DR

A Down syndrome infant with severe FPIES safely tried new high-risk foods in a hospital setting, avoiding serious reactions at home.

Contribution

First case report of hospital-based oral food challenges for a Down syndrome infant with multiple-food FPIES.

Findings

Hospital-based OFCs safely introduced wheat, soy seasoning, and egg white without adverse reactions.

Egg yolk triggered vomiting, requiring prompt medical intervention.

Dietary restrictions were adjusted to exclude peas, soy, milk, and egg yolk, leading to symptom-free status.

Abstract

Down syndrome (DS) is a risk factor for severe food protein-induced enterocolitis syndrome (FPIES), with DS patients tending to have multiple-food FPIES. This is the first case where a DS infant with a history of severe chronic FPIES to milk and soy could effectively be introduced with some untested high-risk foods through hospital-based oral food challenges (OFCs).

The infant is a 20-month-old girl with DS, who was diagnosed with milk- and soy-induced FPIES. Considering her history of intensive care unit care for severe FPIES reactions, we considered that introducing other high-risk foods, such as wheat and hen’s egg (white and yolk), at home was not appropriate for her. We offered hospital-based OFCs effectively and safely by introducing wheat and hen’s egg as high-risk foods against FPIES to the 20-month-old infant. As a result, she tolerated soy-based seasoning, wheat, and egg whites without any symptoms, but she developed frequent vomiting after ingesting egg yolk. We did a prompt intervention with intravenous fluid replacement to prevent severe adverse conditions. After discharge, she exhibited an FPIES symptom as a consequence of ingesting green peas and miso; hence, we recommended the elimination of peas, in addition to soy, milk, and egg yolk, from her diet. She remained symptom-free since adhering to this dietary regimen.

In severe FPIES children, it is encouraged to introduce unconsumed high-risk foods in the hospital safely to avoid severe reactions at home and prevent unnecessary food eliminations.

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