Food Challenges

  • Kathleen Y. Wang
  • Antonella Cianferoni


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.


Food challenge Protocol Dosing IVF Ondansetron 


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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

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