Early infancy dysbiosis in food protein‐induced enterocolitis syndrome: A prospective cohort study

• Published in: Allergy (Copenhagen) Vol. 78; no. 6; pp. 1595 - 1604
• Main Authors: Su, Kuan‐Wen, Cetinbas, Murat, Martin, Victoria M., Virkud, Yamini V., Seay, Hannah, Ndahayo, Renata, Rosow, Rachael, Elkort, Michael, Gupta, Brinda, Kramer, Eileen, Pronchick, Tetiana, Reuter, Susan, Sadreyev, Ruslan I., Huang, Jing‐Long, Shreffler, Wayne G., Yuan, Qian
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.06.2023
• Subjects: Acinetobacter lwoffii; Allergens; Bacteroides fragilis; Bifidobacterium adolescentis; birth cohort study; Child; Children; Cohort analysis; cohort studies; Dietary Proteins - adverse effects; digestive system; Dysbacteriosis; Dysbiosis; Enterocolitis; Enterocolitis - diagnosis; Enterocolitis - epidemiology; Enterocolitis - etiology; Food allergies; food allergy; Food Hypersensitivity - diagnosis; food protein‐induced enterocolitis syndrome; FPIES; Holdemania; Humans; infancy; Infant; intestinal microorganisms; Lachnobacterium; Male; males; microbiome; Microbiomes; milk; oats; pathogenesis; Prospective Studies; rice; RNA, Ribosomal, 16S - genetics; rRNA 16S; short chain fatty acids; Stool microbiome; Syndrome; FPIES; birth cohort study; Stool microbiome; food allergy; food protein-induced enterocolitis syndrome
• ISSN: 0105-4538; 1398-9995; 1398-9995
• DOI: 10.1111/all.15644

Background The microbiome associations of food protein‐induced enterocolitis syndrome (FPIES) are understudied. We sought to prospectively define the clinical features of FPIES in a birth cohort, and investigate for the evidence of gut dysbiosis. Methods We identified children diagnosed with FPIES in the Gastrointestinal Microbiome and Allergic Proctocolitis Study, a healthy infant cohort. Children were assessed and stools were collected at each well child visit. The clinical features of the children with FPIES were summarized. Stool microbiome was analyzed using 16S rRNA sequencing comparing children with and without FPIES. Results Of the 874 children followed up for 3 years, 8 FPIES cases (4 male) were identified, yielding a cumulative incidence of 0.92%. The most common triggers were oat and rice (n = 3, each) followed by milk (n = 2). The children with FPIES were more likely to have family history of food allergy (50% vs. 15.9% among unaffected, p = .03). The average age of disease presentation was 6 months old. During the first 6 months of life, stool from children with FPIES contained significantly less Bifidobacterium adolescentis, but more pathobionts, including Bacteroides spp. (especially Bacteroides fragilis), Holdemania spp., Lachnobacterium spp., and Acinetobacter lwoffii. The short‐chain fatty acid (SCFA)‐producing Bifidobacterium shunt was expressed significantly less in the stool from FPIES children. Conclusions In this cohort, the cumulative incidence over the 3‐year study period was 0.92%. During the first 6 months of life, children with FPIES had evidence of dysbiosis and SCFA production pathway was expressed less in their stool, which may play an important role in the pathogenesis of FPIES. The incidence of FPIES in 3 years in a healthy birth cohort was 0.92%. The average age of disease presentation was 6 months. The most common FPIES triggers are oat and rice, followed by cow's milk. Dysbiosis, more pathobionts and less commensal bacteria were noted since birth from the stools of FPIES children.Abbreviations: FPIES, food protein‐induced enterocolitis syndrome; LDA, linear discriminant analysis; SCFAs, short chain fatty acid