*Article* **Food Protein-Induced Enterocolitis Syndrome in Children with Down Syndrome: A Pilot Case-Control Study**

**Fumiko Okazaki <sup>1</sup> , Hiroyuki Wakiguchi 1,\*, Yuno Korenaga <sup>1</sup> , Kazumasa Takahashi <sup>1</sup> , Hiroki Yasudo <sup>1</sup> , Ken Fukuda <sup>1</sup> , Mototsugu Shimokawa <sup>2</sup> and Shunji Hasegawa <sup>1</sup>**


**Abstract:** Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobin E-mediated food hypersensitivity disorder. However, little is known about the clinical features of FPIES in patients with Down syndrome (DS). Medical records of children with DS diagnosed at our hospital between 2000 and 2019 were retrospectively reviewed. Among the 43 children with DS, five (11.6%) were diagnosed with FPIES; all cases were severe. In the FPIES group, the median age at onset and tolerance was 84 days and 37.5 months, respectively. Causative foods were cow's milk formula and wheat. The surgical history of colostomy was significantly higher in the FPIES group than in the non-FPIES group. A colostomy was performed in two children in the FPIES group, both of whom had the most severe symptoms of FPIES, including severe dehydration and metabolic acidosis. The surgical history of colostomy and postoperative nutrition of formula milk feeding may have led to the onset of FPIES. Therefore, an amino acid-based formula should be considered for children who undergo gastrointestinal surgeries, especially colostomy in neonates or early infants. When an acute gastrointestinal disease is suspected in children with DS, FPIES should be considered. This may prevent unnecessary tests and invasive treatments.

**Keywords:** cow's milk allergy; food allergy; food hypersensitivity; gastrointestinal disorder; non-IgE-mediated food hypersensitivity disorder; wheat allergy
