Children with Food Allergies May Benefit from Home Reintroduction of FPIES

The home reintroduction of pediatric food protein-Induced enterocolitis syndrome (FPIES) food triggers may be considered a safe option for cautious selection among children who are known to have food allergies, according to new findings.¹

These findings, to be presented at the 2024 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting in Washington DC, resulted from new research which was conducted to address concerns related to financial burden and resources involved in oral food challenges.

“Conducting supervised oral food challenges (OFC) 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,” primary author, Ashna Mehra, DO, said in a statement.

A retrospective chart review was carried out by Mehra and her team of investigators with the goal of exploring the ever-changing landscape of FPIES. Mehra and colleagues specifically looked at pediatric FPIES patients who had been seen at the NYU Langone Pediatric Allergy and Immunology Clinic from September 2019 - November 2022.

Over the course of the study, the research team ended up reviewing 226 individuals. The team found that several different allergic comorbidities were shown to be prevalent among these patients, reporting that 54.3% had eczema and 20.6% had IgE-mediated food allergy.

The research team also found that acute FPIES was reported in 98% of the cases they assessed, adding that 12% ended up having atypical reactions to peanut, egg, cow's milk, oat, rice, wheat, rye, and tree nuts. The team’s analysis showed that the initial severity of FPIES reactions was shown to be mild among about 90.7% of individuals assessed, moderate among 5.6%, and severe among 3.7%.

The investigators added that smaller percentages had reported rhinitis, eosinophilic esophagitis, urticaria, asthma, and allergies to various drugs. They further investigated 107 individuals over the course of their study, and noted that the median age of patients at the initial FPIES reaction was shown to be 6 months.

A median age of 23.5 months was determined by the research team, and the team added that 28 of the subjects had attempted reintroduction of FPIES food triggers. Specifically, the investigators noted that 71.5% did so while at home and 28.5% did so while in a medical facility as a formal food challenge.

An 80% success rate was identified by the research team for reintroductions. Another notable finding from the study was that all of the reactions occurring at home were shown to be mild, but 80% of reactions occurring at medical centers were shown to be moderate, and the remaining 20% mild.

The newfound consideration of home reintroduction as safe for carefully-selected children could allow for more treatment options and the possibility of better life quality and outcomes. Overall, the team’s findings may allow for several new insights into the landscape of FPIES, especially as new foods become known as common allergy triggers.

These findings contribute to recent additions to the literature on early introduction for food allergy patients, such as research on the importance of earlier introduction of allergenic food products in the first year of a child’s life.²

“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 and colleagues wrote. “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.”¹

References

1. ^{Home Reintroduction of FPIES Food Triggers May Be Safe and Effective for Children. American Academy of Allergy, Asthma & Immunology. February 5, 2024. https://www.aaaai.org/about/news/news/2024/fpies#:~:text=This%20research%20allows%20for%20a,of%20life%2C%20the%20research%20shows. Date accessed: February 22, 2024.}
2. ^{Smith T. Allergenic Food Introduction Led to Fewer Allergies, Higher Withdrawal Rate from Intervention. HCPLive. April 8, 2023. https://www.hcplive.com/view/allergenic-food-introduction-fewer-allergies-higher-withdrawal-rate-intervention. Date accessed: February 22, 2024.}