Children with FPIES may tolerate reintroduction of reaction triggers at home

Key takeaways:

• Patients who reintroduced triggers at home had mild initial reactions.
• 80% of reintroductions overall were successful.
• Reactions during reintroductions at home were all mild.

WASHINGTON — Some children with food protein-induced enterocolitis syndrome may safely reintroduce triggers into their diets at home, according to a study presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

More treatment options, better outcomes and improved quality of life are possible as well, Ashna Mehra, DO, of the NYU Grossman Long Island School of Medicine, and colleagues wrote.

“Conducting supervised oral food challenges 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,” Mehra said in a press release.

“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,” she continued.

The retrospective chart review examined the records of 226 pediatric patients with FPIES (50.2% girls) who were seen by the NYU Langone Pediatric Allergy and Immunology Clinic between Sept. 1, 2019, and Nov. 4, 2022.

Allergic comorbidities in this cohort included atopic dermatitis (54.3%), IgE-mediated food allergy (20.6%), urticaria (6.7%), rhinitis (6.3%), asthma (4%), eosinophilic esophagitis (1.8%) and drug allergy (1.8%).

Further analysis of 107 patients (48.6% girls) indicated a median age of 6 months (interquartile range [IQR], 5-7) for the first FPIES reaction. Severity included mild (90.7%), moderate (5.6%) and severe (3.7%).

Triggers included cereal grains (27%), fruit (21%), vegetables (12%), egg (11%), peanut (7%), cow’s milk (6.5%), meats (3.5%), soy (2.5%), tree nut (1.5%), shellfish (1%), fish (0.5%) and goat’s milk (0.5%).

Also, 98% had acute FPIES, with 12% reporting atypical FPIES to egg, peanut, oat, cow’s milk, rice, rye wheat and tree nut. The researchers also noted that egg, peanut and avocado are emerging as common triggers.

Twenty-eight patients attempted to reintroduce their triggers into their diets at a median age of 23.5 months (IQR, 15-30) during 34 attempts, including 71.5% who attempted slow reintroduction at home and 28.5% who did so as a formal food challenge in a medical facility.

The researchers classified 80% of these reintroductions overall as successful, which they defined as tolerance of an age-appropriate amount of food that had previously triggered an FPIES reaction. Specifically, 87.5% of the reintroductions at home were successful, compared with 50% of the formal food challenges that took place in medical facilities.

The patients who tolerated reintroductions had a median age of 23 months, and those who had reactions had a median age of 23.5 months, which the researchers considered comparable.

Specifically, the patients who successfully reintroduced triggers at home did so at a median age of 21 months, and those who did so during a formal food challenge in a medical facility had a median age of 26 months.

Also, the researchers categorized all the reactions that occurred at home during these reintroductions as mild. Among the reactions following reintroduction at medical facilities, 80% were moderate and 20% were mild.

With reactions considered mild upon initial introduction and upon reintroduction at home, the researchers said that carefully preselected children may be candidates for home reintroduction.

“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,” Mehra said.

Reference:

• Home reintroduction of FPIES food triggers may be safe and effective for children. https://www.aaaai.org/about/news/news/2024/fpies. Published Feb. 5, 2024. Accessed March 18, 2024.
• Mehra A, et al. J Allergy Clin Immunol. 2024;doi:10.1016/j.jaci.2023.11.626.