Home Reintroduction of FPIES Food Triggers May Be Safe and Effective for Children

February 5, 2024

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80% of FPIES food trigger reintroductions were successful, while all at-home reintroduction reactions were deemed as “mild.”

MILWAUKEE – Home reintroduction of pediatric food protein-Induced enterocolitis syndrome (FPIES) food triggers may be safe for carefully preselected children with food allergies according to new research being presented at the 2024 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting, in Washington, DC this month.
 
“Conducting supervised oral food challenges (OFC) for FPIES may incur significant expenses for families, require specific resources and personnel leading to limited accessibility and cause potential distress to pediatric patients due to the clinical environment and preparatory measures such as intravenous access. Continued research in this area will enable allergists to make shared decisions with patient families, identifying suitable candidates among children with FPIES for gradual home reintroduction of triggers at appropriate ages. 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 OFC,” said primary author, Ashna Mehra, DO.
 
To examine the changing landscape of FPIES, researchers performed a retrospective chart review of pediatric FPIES patients seen in the NYU Langone Pediatric Allergy and Immunology Clinic from September 1, 2019, to November 4, 2022.
 
Among 226 patients, allergic comorbidities were common with 54.3% of participants having atopic dermatitis, 20.6% having IgE-mediated food allergy and smaller percentages having urticaria, rhinitis, asthma, eosinophilic esophagitis and drug allergies. Researchers further analyzed 107 patients with the median age at initial FPIES reaction being 6 months old. Ninety-eight percent of participants had acute FPIES and 12% had atypical FPIES to egg, peanut, oat, cow's milk, rice, rye, wheat and tree nuts.  
 
The review found that initial FPIES reaction severity was mild for 90.7% of participants, moderate for 5.6% of participants and severe for 3.7% of participants. With a median age of 23.5 months, 28 patients attempted reintroduction of FPIES food triggers with 71.5% of reintroduction at home and 28.5% in a medical facility as a formal food challenge. Results found that 80% of reintroductions were successful. All reactions at home were classified as mild while 80% of reactions performed at a medical facility were classified as moderate and 20% were mild.

This research allows for a better understanding of the current landscape of FPIES as new foods are emerging as common triggers. With home reintroduction considered safe for carefully preselected children, children have more treatment options and may have better outcomes and improved quality of life, the research shows.
 
Visit aaaai.org to learn more about FPIES. Research presented at the 2024 AAAAI Annual Meeting, February 23-26 in Washington, DC, is published in an online supplement to The Journal of Allergy and Clinical Immunology.

The American Academy of Allergy, Asthma & Immunology (AAAAI) is the leading membership organization of more than 7,100 allergists, asthma specialists, clinical immunologists, allied health professionals and other professionals with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 7,100 members in the United States, Canada and 72 other countries and is the go-to resource for patients living with allergies, asthma and immune deficiency disorders.