Trends in Provider Management of Patients with Food Protein Induced Enterocolitis Syndrome
Tuesday, February 24, 2015: 2:15 PM
Room 360 DEF (Convention Center)
J. Andrew Bird, MD FAAAAI, ,
Rationale: Food Protein Induced Enterocolitis Syndrome (FPIES) is a non-IgE mediated food allergy with unclear prevalence.  Provider-level variation in FPIES management is poorly understood.

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.