Oral food challenge with a mixture of 'at risk' foods in children with FPIES

ABSTRACT Background. Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy. In addition to the elimination diet regarding the culprit food, it has been proposed to avoid, for the 1st year of life, certain foods (legumes, cereals, poultry), which are considered at risk. This suggestion may not be appropriate in countries where the prevalence of multiple foods FPIES is low. We evaluated the usefulness of an oral food challenge (OFC) with a mixture of these “at risk” foods. Methods. Children with acute FPIES younger than one year were enrolled. Skin prick tests (SPT) with commercial extracts and cooked foods were performed with legumes, cereals, poultry. All children performed an OFC with a mixture of these foods. After 3 months, the patients who passed OFC were contacted by telephone to verify the persistence of “at risk” foods tolerance at home. Results. Fourteen children were enrolled, 13 with cow's milk FPIES and 1 with wheat FPIES. The SPT were always negative. All children passed the OFC and continued to eat "at risk" foods at home without adverse reactions. Conclusions. To perform an OFC with a mixture of “at risk” foods for children with acute FPIES is a convenient and safe practice in countries where the prevalence of multiple foods FPIES is low. This procedure can avoid unnecessary elimination diet.