of the challenge and the child is monitored for up to 6-8 hours afterwards . 1 , 10 Many centers obtain blood samples throughout the challenge looking for a rise in the absolute neutrophil count which can signal an impending FPIES reaction . If the child does not experience FPIES symptoms by the conclusion of the challenge , he or she may then include the challenge food in the diet moving forward . If symptoms are experienced , management of the reaction is performed as above .
FPIES is a relatively recently described condition that is often misdiagnosed in the pediatric population . There are many reasons for this , including confusion with Ig-E mediated reactions or gastroesophageal reflux , and the frequency of viral gastroenteritis causing similar symptoms in this population . Therefore , it is important for the family to have an FPIES action plan , both to inform treating physicians of their condition as well as to provide treatment recommendations . It should be noted that this should serve a guide , but not exclude other diagnoses if the treating physician feels that other diagnoses are more likely . Increased awareness and recognition of this disease by emergency medicine and primary care practitioners is imperative both for acute symptom management and for appropriate referral to allergists for long term management , leading to increased quality of life for patients and their families .
References
1 . Nowak-Wegrzyn A , Chehade M , Groetch ME , et al . International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome : Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee , American Academy of Allergy , Asthma & Immunology . J Allergy Clin Immunol . 2017 ; 139 ( 4 ): 1111-1126 . e4 . 2 . Boyce JA , Assa ' ad A , Burks AW , et al . Guidelines for the diagnosis and management of food allergy in the United States : report of the NIAID-sponsored expert panel . J Allergy Clin Immunol . 2010 ; 126 ( 6 Suppl ): S1-58 . 3 . Blackman AC , Anvari S , Davis CM , Anagnostou A . Emerging triggers of food protein-induced enterocolitis syndrome : Lessons from a pediatric cohort of 74 children in the United States . Ann Allergy Asthma Immunol . 2019 ; 122 ( 4 ): 407-411 . 4 . Alonso SB , Ezquiaga JG , Berzal PT , et al . Food protein-induced enterocolitis syndrome : Increased prevalence of this great unknown-results of the PREVALE study . J Allergy Clin Immunol . 2019 ; 143 ( 1 ): 430-433 . 5 . Goswami R , Blazquez AB , Kosoy R , Rahman A , Nowak-Wegrzyn A , Berin MC . Systemic innate immune activation in food protein-induced enterocolitis syndrome . J Allergy Clin Immunol . 2017 ; 139 ( 6 ): 1885-1896 . e9 . 6 . Pecora V , Prencipe G , Valluzzi R , et al . Inflammatory events during food protein-induced enterocolitis syndrome reactions . Pediatr Allergy Immunol . 2017 ; 28 ( 5 ): 464-470 . 7 . Caubet JC , Nowak-Wegrzyn A . Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome . Expert Rev Clin Immunol . 2011 ; 7 ( 3 ): 317-27 . 8 . Miceli Sopo S , Bersani G , Monaco S , et al . Ondansetron in acute food protein-induced enterocolitis syndrome , a retrospective case-control study . Allergy . 2017 ; 72 ( 4 ): 545-551 . 9 . Caubet JC , Cianferoni A , Groetch M , Nowak-Wegrzyn A . Food protein-induced enterocolitis syndrome . Clin Exp Allergy . 2019 ; 49 ( 9 ): 1178-1190 . 10 . Wang KY , Lee J , Cianferoni A , et al . Food Protein-Induced Enterocolitis Syndrome Food Challenges : Experience from a Large Referral Center . J Allergy Clin Immunol Pract . 2019 ; 7 ( 2 ): 444-450 .
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