Methods: A 23-question on-line survey was administered to AAAAI members
Results: Among 470 respondents, 64% reported “full understanding” of FPIES diagnosis/management, and 81.1% reported managing >1 FPIES patient. 80.4% correctly identified an FPIES case vignette. 82.5% and 71.3% correctly differentiated FPIES from infantile colic or dietary proctitis. Among providers currently managing FPIES patients, 47.5% indicated soy formula, 73.8% breast milk, and 94.5% elemental formula were appropriate substitutes in cow milk (CM) FPIES. 73.4% indicated performing skin testing, 62.2% serum IgE testing, 12.7% patch testing, 36.8% oral challenge, and 28% no testing in diagnosing FPIES. 84% provide FPIES patients with allergy action plans, 72.8% provide a personalized emergency management letter, and 21% prescribe epinephrine auto-injectors. Odds of prescribing epinephrine were lower among those reporting “full understanding” of FPIES (OR 0.41, 95%CI 0.21-0.79). Academic providers had higher odds of providing an action plan (OR 2.4, 95%CI 1.17-4.98) and performing diagnostic OFC (OR 1.99, 95%CI 1.99-3.25), but not of correct vignette differentiation of FPIES from other conditions, correct identification of appropriate CM-FPIES substitutes, or a preferred timing for food re-introduction. More years in practice were associated with lower odds of reporting full understanding of FPIES diagnosis/management (OR 0.96, 95%CI 0.94-0.99).
Conclusions: Nearly 1/3 of respondents reported poor familiarity with FPIES. Considerable variation exists in use of diagnostic tests, management, and choice of “safe” nutrition. These data indicate a strong need for FPIES practice guidelines.