Food Protein-Induced Enterocolitis Syndrome Food Challenges: Experience from a Large Referral Center

Area of Science:

• Pediatric Allergy and Immunology
• Gastroenterology

Background:

• Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy.
• Diagnosis relies on clinical findings, with oral food challenges (OFCs) used for confirmation and tolerance assessment.
• Existing studies on FPIES OFCs are often limited in scope.

Purpose of the Study:

• To describe the experience and safety of OFCs using a specific FPIES protocol.
• To evaluate the outcomes of OFCs in a cohort of patients with suspected FPIES.
• To assess the development of tolerance to specific foods in FPIES patients.

Main Methods:

• Retrospective chart review of patients undergoing OFC via the FPIES protocol (2014-2017).
• Protocol involved initial partial serving with 4-hour observation, followed by home titration.
• Data collected included reaction history, age, and reactions during challenge or home introduction.

Main Results:

• 169 OFCs were completed in 119 patients across 19 foods.
• 18% of challenges were positive (10% during initial challenge, 7.7% during home dosing).
• 82% of OFCs were negative, indicating tolerance; early intravenous fluids (IVF) were often needed but hypotension was rare. Milk, soy, and grain challenges were passed at an earlier mean age.

Conclusions:

• The FPIES OFC protocol is deemed safe.
• Early IVF administration may prevent hypotension during reactions.
• Stratifying risk for severe/delayed reactions and identifying candidates for home introduction requires further research.