Fifth Criterion: 'A Standardized Food Challenge or Isolated Re-exposure Elicited the Typical Symptoms'
Leonard et al. also do not change anything about this criterion. Even if this standard is considered necessary for FPIES diagnosis, it is not always observed in clinical practice, as doctors are scared of its consequences since during the acute phase the child may feel very unwell. This is the reason why many allergists refuse to perform an OFC if they are aware of the occurrence of only one typical episode. Adding to all this, parents often refuse to re-expose their babies to the suspected food. Many cases of FPIES diagnosis based on a single and severe episode were even published in literature,[3,4] but we do not agree with this attitude, as there can be a high risk of wrong diagnosis and a consequent elimination of important foods from the patient's diet. On the contrary, we believe that the best way to make a correct diagnosis is the presence in the patient's clinical history of at least two typical episodes, one of which could be a failed OFC. Unlike Powell and in agreement with Leonard et al., we do not believe that the ingestion of culprit food must necessarily be isolated. In summary, we think that the fifth Powell and Leonard et al. criterion has to be respected. From practice to theory: Bridget performed an OFC, as she presented only one typical episode, while Ernst did not do the same, as he experienced FPIES symptoms three times.
Expert Rev Clin Immunol. 2013;9(8):707-715. © 2013 Expert Reviews Ltd.