Safety of Performing Oral Food Challenges to Food Protein-Induced Enterocolitis Syndrome Patients in the Outpatient Clinic


      Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food reaction typically occurring in young infants that resolves over time, and the oral food challenge (OFC) remains the gold standard for evaluating its resolution. We wanted to investigate utilization and safety outcomes of OFCs in FPIES patients seen in the outpatient setting.


      Chart review was performed of 1460 patients with a visit diagnosis of “food allergy” or “food hypersensitivity” seen in a tertiary care referral allergy clinic between Oct 2009 and Dec 2013. Twenty five patients were identified with FPIES.


      The mean age at diagnosis was 8.5 months. 40% of patients were male, 12% had concomitant IgE-mediated food allergy, and 20% had other atopic conditions (most frequently atopic dermatitis). Most common foods implicated were rice (64%), oat (48%), and cow’s milk (28%). 68% of patients had reactions to more than one food. 38 OFCs were performed, with a mean age of 34 months at first OFC. 12 challenges were performed at home and 26 challenges were performed in the office, 22 as food re-introductions after a previous reaction and 16 as initial food introductions. One OFC failed at home and five OFCs failed in the office. Milk was the most common trigger for failed challenges. Most failed challenges were treated with observation and oral hydration but one challenge required transfer to the emergency department and treatment with intravenous fluids and steroids.


      In carefully selected patients, OFC can be performed in the clinic without intravenous access if emergency services are easily accessible.