Objective

Food protein-induced enterocolitis syndrome (FPIES) is typically diagnosed based on a characteristic clinical history; however, an oral food challenge (OFC) may be necessary to confirm the diagnosis or evaluate for the development of tolerance. FPIES OFC methods vary globally, and there is no universally agreed upon protocol. The objective of this review is to summarize reported FPIES OFC approaches and consider unmet needs in diagnosing and managing FPIES.

Data Sources

PubMed database was searched using the keywords food protein-induced enterocolitis syndrome, oral food challenge, cow milk allergy, food allergy, non-immunoglobulin E–mediated food allergy and FPIES.

Study Selections

Primary and review articles were selected based on relevance to the diagnosis of FPIES and the FPIES OFC.

Results

We reviewed the history of FPIES and the evolution and variations in the FPIES OFC. A summary of current literature suggests that most patients with FPIES will react with 25% to 33% of a standard serving of the challenged food, there is little benefit to offering a divided dose challenge unless there is suspicion of specific immunoglobulin E to the food being challenged, reactions typically appear within 1 to 4 hours of ingestion, and reactions during OFC rarely result in emergency department or intensive care unit admission.

Conclusion

International standardization in the FPIES OFC approach is necessary with particular attention to specific dose administration across challenged foods, timing between the patient’s reaction and offered OFC to verify tolerance, patient safety considerations before the OFC, and identification of characteristics that would indicate home reintroduction is appropriate.

中文翻译：

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食物蛋白诱发的小肠结肠炎综合征口服食物挑战

客观的

食物蛋白诱发的小肠结肠炎综合征（FPIES）通常根据特征性的临床病史进行诊断；但是，可能需要口服食品挑战（OFC）来确认诊断或评估耐受性的发展。FPIES OFC方法在全球范围内有所不同，还没有普遍同意的协议。这次审查的目的是总结报告的FPIES OFC方法，并考虑诊断和管理FPIES中未满足的需求。

数据源

使用关键词食物蛋白诱导的小肠结肠炎综合征，口服食物挑战，牛奶过敏，食物过敏，非免疫球蛋白E介导的食物过敏和FPIES来搜索PubMed数据库。

研究选择

根据与FPIES和FPIES OFC的诊断的相关性选择主要和综述文章。

结果

我们回顾了FPIES的历史以及FPIES OFC的演变和变化。当前文献的总结表明，大多数FPIES患者将对标准食物中25％至33％的受挑战食物产生反应，除非怀疑食品中存在特定的免疫球蛋白E，否则分剂量挑战几乎没有好处。受到挑战后，反应通常会在摄入后1至4个小时内出现，并且OFC期间的反应很少导致急诊科或重症监护病房入院。

结论

FPIES OFC方法的国际标准化是必要的，尤其要注意挑战食品中的特定剂量给药，患者反应和提供的OFC之间的时间间隔以验证耐受性，在OFC之前考虑患者安全考虑因素以及确定表明需要重新引入家庭的特征。