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.
KeywordsFood challenge Protocol Dosing IVF Ondansetron
- 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