FPIES: The 'Other' Food Allergy

Anna Nowak-Wegrzyn, MD


April 03, 2013

Guidance for Oral Food Challenges

An OFC is used to determine whether FPIES has resolved before the food is reintroduced into the diet. In one conservative approach, follow-up challenges are recommended every 18-24 months in patients without recent reactions.[6] However, in a study of 27 Korean infants with CM FPIES, 64% tolerated CM at 10 months, and 92% tolerated soy at 10 months.[8] These investigators recommended follow-up challenge be undertaken sooner: after 12 months of age for CM and at 6-8 months of age for soy. Further studies are needed to establish the optimal timing of follow-up challenges.

The follow-up evaluation should include testing for food-specific IgE prior to the OFC because patients who initially present with food-specific IgE antibodies as well as those who develop them at a later age are at risk for persistent FPIES.[9] Determination of when and how to perform a follow-up challenge in the small proportion of patients who develop positive skin-prick tests and/or detectable food-specific IgE levels should also take into consideration the possibility of an acute IgE-mediated reaction. A modified OFC protocol with more incremental food dose administration and availability of appropriate medications such as epinephrine and an antihistamine is recommended in these cases.