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Background: Gut microbial composition has been proposed to influence disease onset in children with food protein–induced enterocolitis syndrome (FPIES).

Objective: We sought to investigate differences in gut microbiota profiles in children with newly diagnosed FPIES and healthy control subjects.

Methods: Fecal samples were collected at FPIES diagnosis from 56 children stratified into 3 age groups: mean (SD) age 4.6 (0.5) months, 6.5 (0.6) months, and 11.7 (7.8) months. Gut microbiota profiles were analyzed using 16S ribosomal RNA gene amplicon sequencing and compared between children with FPIES and 43 age-matched control subjects.

Results: Age was the strongest determinant of gut microbiota composition, followed by FPIES status. β-diversity differed significantly between children with FPIES and control subjects (P < .01), primarily driven by shifts in Bacteroidota, Proteobacteria, Actinobacteriota, and Verrucomicrobiota. Children with FPIES had lower Bifidobacterium and higher abundances of Bacteroides, Haemophilus, and Veillonella. FPIES food triggers were associated with reduced Verrucomicrobiota abundance.

Conclusions: Children with FPIES exhibit gut microbial dysbiosis characterized by reduced Bifidobacterium and Verrucomicrobiota abundance, suggesting potential links between early-life microbiota development and disease pathogenesis.

Aim: To describe clinical presentation and development of tolerance among children with Food protein-induced enterocolitis syndrome (FPIES) in a population in northern Sweden.

Methods: A retrospective review of medical records of children presenting with FPIES symptoms from 1 January 2004, to 31 May 2018.

Results: Sixty children (65% boys) with FPIES were included. The estimated incidence gradually increased to 0.45% in 2016–2017. The most common food triggers were cow's milk (40%), fish (37%) and oat (23%). Symptoms presented in 31 (60%) children before 6 months and in 57 (95%) before 1 year of age. The median age for FPIES diagnosis was 7 (range 3–134) months and for fish FPIES 13 (range 7–134) months. By 3 years of age, 67% of children with FPIES to milk and oat but none of the children with fish FPIES had developed tolerance. Allergic conditions like eczema and asthma were reported in 52% of the children.

Conclusion: The cumulative FPIES incidence was 0.45% in 2016–2017. Most children presented with symptoms before 1 year of age, but the diagnosis was often delayed, especially for FPIES to fish. Tolerance development occurred at an earlier age when FPIES was triggered by milk and oat compared to fish.