Food Protein-Induced Enterocolitis Syndrome Food Challenges: the Childrens Hospital of Philadelphia Experience

Extensive information on oral food challenges (OFC) for food protein-induced enterocolitis syndrome (FPIES) is limited. We reviewed our experience at the Children’s Hospital of Philadelphia, focusing on prior history, number of reactions, and safety. Patients who completed OFC via FPIES protocol from September 1, 2014 to August 16, 2017 were retrospectively reviewed. Of the 2647 OFCs completed, 194 were by FPIES protocol. Milk challenges were performed commonly (73), followed by grains (54) and soy (38). Prior patient history included FPIES reaction to challenged food (126), FPIES reaction to different food (42), or proctocolitis (26). 18 patients (9.3%) developed acute FPIES reactions during challenge: one transferred to ED, and three hospitalized overnight (including one in the ICU). 13 received IV fluid boluses and 10 received ondansetron. Reactions were to milk (8), oat (3), soy (2), sweet potato (2), squash (1), potato (1), and turkey (1). 14 patients (7.2%) tolerated initial hospital challenges but had delayed reactions to home dosing: one observed in the ED and others managed at home. Reactions were to milk (7), soy (3), rice (2), oat (1), and corn (1). 162 patients (83.5%) tolerated hospital challenge and home dosing. All patients with proctocolitis tolerated initial challenge; though two developed diarrhea with home introduction. Although the majority of patients undergoing OFC via FPIES protocol tolerated the challenge, the ability to treat those with reactions with fluid boluses is of utmost importance. We also found that in our cohort of patients with proctocolitis, introduction at home appears to be safe.