HOME reintroduction of paediatric food protein-induced enterocolitis syndrome (FPIES) food triggers may be safe for carefully pre-selected children, according to new research presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2024 Annual Meeting.
FPIES is a non-IgE-mediated food allergy with potentially severe symptoms, significantly affecting the quality of life of patients and caregivers. The team performed a retrospective chart review of paediatric FPIES patients seen in the NYU Langone Pediatric Allergy and Immunology Clinic, New York, USA, from September 1st 2019–November 4th 2022, to examine the evolving landscape in FPIES management.
Among 226 patients examined in the study, allergic comorbidities were common: 54.3% of participants had atopic dermatitis; 20.6% had IgE-mediated food allergy; and smaller percentages had urticaria, rhinitis, asthma, eosinophilic oesophagitis, or drug allergies. In a further analysis of 107 patients, researchers found that 98% had acute FPIES, and 12% had atypical FPIES to egg, peanut, oat, cow’s milk, rice, rye, wheat, and tree nut. The median age at initial FPIES reaction was 6 months. Initial FPIES reaction severity was mild for 60.7% of participants, moderate for 5.6%, and severe for 3.6%.
At a median age of 23.5 months, 28 patients attempted reintroduction of FPIES food triggers, with 71.5% of reintroductions performed at home, and 28.5% performed in a medical facility as a formal food challenge. The team found that 80% of reintroductions were successful, and all at-home reintroduction reactions were classified as mild. Furthermore, 80% of reactions at a medical facility were classified as moderate, and 20% were classified as mild.
The authors concluded that gradual home reintroduction of FPIES food triggers is a safe option for pre-selected children, offering the potential for improved quality of life. “Implementing efficient home reintroduction, supported by thorough training for families and effective physician communication, can mitigate the financial, temporal, and emotional burden often associated with supervised FPIES oral food challenges,” emphasised lead author Ashna Mehra, NYU Grossman Long Island School of Medicine, New York, USA.
