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

Publication date: Available online 20 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Kathleen Y. Wang, Juhee Lee, Antonella Cianferoni, Melanie A. Ruffner, Amy Dean, Jerome M. Molleston, Nicholas A. Pawlowski, Jennifer Heimall, Rushani W. Saltzman, Gita S. Ram, Joel Fiedler, Laura M. Gober, Jonathan M. Spergel, Terri F. Brown-Whitehorn

Abstract

BACKGROUND

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy that is diagnosed based on clinical findings, but can be confirmed with oral food challenge (OFC). OFC is more often performed to assess development of tolerance. Most studies describing OFC in FPIES are limited in size.

OBJECTIVE

We sought to describe our experience with OFCs using our FPIES protocol. Patients were given one-third of serving size with a four hour observation period, followed by home titration to full dose.

METHODS

We conducted a retrospective chart review of patients who underwent OFC via FPIES protocol from 2014 to 2017. Data regarding history of reaction, age at time of challenge, and reactions during challenge or with home introduction was collected.

RESULTS

A total of 169 OFCs were completed under FPIES protocol, in 119 patients to 19 different foods. Thirty challenges (18%) were positive, with 17 challenges (10%) during initial challenge and 13 (7.7%) during home dosing. Most reactions during initial challenge required intravenous fluids (IVF), but hypotension was uncommon. One hundred thirty-nine (82%) OFCs were negative with home introduction, indicating tolerance to the challenged foods. The mean age of passing a challenge to milk, soy, and grain was earlier than that of other solid foods.

CONCLUSION

Our data suggests that our FPIES OFC protocol is safe. Early administration of IVF may prevent the development of hypotension. It is difficult to stratify risk of severe or delayed reaction based on patient characteristics and more data is needed to identify those appropriate for home introduction.