Advertisement

Food Challenges

  • Kathleen Y. Wang
  • Antonella Cianferoni
Chapter

Abstract

Oral food challenges (OFCs) may be performed in food protein-induced enterocolitis syndrome (FPIES) to confirm the diagnosis of FPIES, to assess for tolerance to cross-reactive foods, or to assess for the resolution of FPIES. FPIES OFCs should be conducted under medical supervision, in a setting where access to intravenous fluids (IVF) is available. Conducting OFCs in the home or other non-medically supervised settings is not advised due to the possibility of severe reactions. FPIES OFCs are generally unmasked since objective symptoms are expected and the potential for bias is low. The protocols and practices vary greatly, but current guidelines recommend a three-dose challenge followed by a long observation period. Major criteria of delayed vomiting and ≥2 minor criteria of lethargy, pallor, delayed diarrhea, hypotension, hypothermia, and increased neutrophil count have to be met to consider a challenge positive. A positive challenge supports continued food avoidance. In the case of a negative challenge, the food can be reintroduced into the diet. The cornerstone of treating acute FPIES reactions is aggressive fluid resuscitation. The use of ondansetron in acute FPIES reactions has not been well established, though it may be helpful as an adjunctive treatment.

Keywords

Food challenge Protocol Dosing IVF Ondansetron 

References

  1. 1.
    Nowak-Węgrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139:1111–26.CrossRefGoogle Scholar
  2. 2.
    Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol. 2005;115:149–56.CrossRefGoogle Scholar
  3. 3.
    Wang KY, Lee J, Cianferoni A, Ruffner MA, Dean A, Molleston JM, et al. Food protein-induced enterocolitis syndrome food challenges: experience from a large referral center. J Allergy Clin Immunol Pract. 2019;7(2):444–50.CrossRefGoogle Scholar
  4. 4.
    Vazquez-Ortiz M, Machinena A, Dominguez O, Alvaro M, Calvo-Campoverde K, Giner MT, et al. Food protein-induced enterocolitis syndrome to fish and egg usually resolves by age 5 years in Spanish Children. J Allergy Clin Immunol Pract. 2017;5:512–5.CrossRefGoogle Scholar
  5. 5.
    Lee E, Campbell DE, Barnes EH, Mehr SS. Resolution of acute food protein-induced enterocolitis syndrome in children. J Allergy Clin Immunol Pract. 2017;5:486–8.CrossRefGoogle Scholar
  6. 6.
    Caubet JC, Ford LS, Sickles L, Järvinen KM, Sicherer SH, Sampson HA, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol. 2014;134:382–9.CrossRefGoogle Scholar
  7. 7.
    Sopo SM, Giorgio V, Dello Iacono I, Novembre E, Mori F, Onesimo R. A multicentre retrospective study of 66 Italian children with food protein-induced enterocolitis syndrome: different management for different phenotypes. Clin Exp Allergy. 2012;42:1257–65.CrossRefGoogle Scholar
  8. 8.
    Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow’s milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011;127:647–53.CrossRefGoogle Scholar
  9. 9.
    Hwang J-B, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. 2009;94:425–8.CrossRefGoogle Scholar
  10. 10.
    Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome. Pediatr Allergy Immunol. 2006;17:251–5.CrossRefGoogle Scholar
  11. 11.
    Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111:829–35.CrossRefGoogle Scholar
  12. 12.
    Sicherer SH, Eigenmann PA, Sampson HA. Clinical features of food-protein induced enterocolitis syndrome. J Pediatr. 1998;133:214–9.CrossRefGoogle Scholar
  13. 13.
    Järvinen KM, Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome (FPIES): current management strategies and review of the literature. J Allergy Clin Immunol Pract. 2013;1:317–22.CrossRefGoogle Scholar
  14. 14.
    Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123(6Supp):S365–83.CrossRefGoogle Scholar
  15. 15.
    Powell GK. Milk- and soy-induced enterocolitis of infancy. Clincal features and standardization of challenge. J Pediatr. 1978;93:553–60.CrossRefGoogle Scholar
  16. 16.
    Powell GK. Food protein-induced enterocolitis of infancy: differential diagnosis and management. Compr Ther. 1986;12:28–37.PubMedGoogle Scholar
  17. 17.
    Feuille E, Nowak-Węgrzyn A. Definition, etiology, and diagnosis of food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol. 2014;14:222–8.CrossRefGoogle Scholar
  18. 18.
    Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123:e459–64.CrossRefGoogle Scholar
  19. 19.
    Ruffner MA, Ruymann K, Barni S, Cianferoni A, Brown-Whitehorn T, Spergel JM. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013;1:343–9.CrossRefGoogle Scholar
  20. 20.
    Holbrook T, Keet CA, Frischmeyer-Guerrerio PA, Wood RA. Use of ondansetron for food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2013;132:1219–20.CrossRefGoogle Scholar
  21. 21.
    Miceli Sopo S, Battista A, Greco M, Monaco S. Ondansetron for food protein-induced enterocolitis syndrome. Int Arch Allergy Immunol. 2014;164:137–9.CrossRefGoogle Scholar
  22. 22.
    Miceli Sopo S, Bersani G, Monaco S, Cerchiara G, Lee E, Campbell D, et al. Ondansetron in acute food protein-induced enterocolitis syndrome, a retrospective case-control study. Allergy. 2017;72:545–51.CrossRefGoogle Scholar
  23. 23.
    Freedman SB, Uleryk E, Rumantir M, Finkelstein Y. Ondansetron an the risk of cardiac arrhythmias: a systematic review and postmarketing analysis. Ann Emerg Med. 2014;64:19–25.e6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kathleen Y. Wang
    • 1
  • Antonella Cianferoni
    • 2
  1. 1.Allergy and ImmunologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Division of Allergy and Immunology, University of Pennsylvania, Perelman School of Medicine, Children’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations