Oat and rice food protein-induced enterocolitis syndrome cross-reactivity
Question:
10/25/2023
I have a 3-year-old with prior diagnosis of oat FPIEs who recently had severe reaction to oat. The patient has never had rice. Practice parameters suggest 50% cross reactivity between oat and rice. I have normally told patients to wait on rice intro before they pass oat challenges. However, I have one pediatric patient with oat FPIEs who is tolerating rice. What has been the experience of the other providers? Would others be ok with challenging oat FPIEs on 3-year-olds to rice even though they are reactive to oat still?
Answer:
Infants with FPIES to grains such as rice, oat, or barley are particularly at risk of developing FPIES to other grains. In American studies, it has been shown that concomitant FPIES to oat and rice can occur in up to 35–44% of patients with FPIES to oat or rice.
Michelet M, Schluckebier D, Petit LM, Caubet JC. Food protein-induced enterocolitis syndrome - a review of the literature with focus on clinical management. J Asthma Allergy. 2017 Jun 27;10:197-207.
Since most children with oat FPIES tolerate rice, it would be reasonable to feed the child rice, under observation, to confirm current tolerance, if it is present, and potentially avoid needlessly restricting the child's dietary options. Your personal observation of one of your patients with oat FPIES tolerating rice is consistent with the medical literature.
Calvani M, Anania C, Bianchi A, D'Auria E, Cardinale F, Votto M, Martelli A, Tosca M, Chiappini E, Brambilla I, Miraglia Del Giudice M, Caffarelli C. Update on Food protein-induced enterocolitis syndrome (FPIES). Acta Biomed. 2021 Nov 29;92(S7):e2021518.
Eric Macy, MD, MS, FAAAAI