TY - JOUR
T1 - Trends in Provider Management of Patients with Food Protein–Induced Enterocolitis Syndrome
AU - Greenhawt, Matthew
AU - Bird, J. Andrew
AU - Nowak-Wegrzyn, Anna H.
N1 - Publisher Copyright:
© 2017
PY - 2017/9
Y1 - 2017/9
N2 - Background Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy. Objective To better understand provider-level variation in FPIES knowledge and management. Methods A 23-question online survey was administered to AAAAI members during the spring and summer of 2014. Results Among 470 respondents, 64% reported “full understanding” of FPIES diagnosis/management; 78.8% reported managing 1 or more patient with FPIES; and 80.4% correctly identified an FPIES case vignette. FPIES was correctly differentiated from infantile colic or food protein–induced allergic proctocolitis by 82.5% and 71.3%, respectively. Among providers currently managing patients with FPIES, 47.5% indicated soy formula, 73.8% breast milk, and 94.5% elemental formula as appropriate substitutes in cow milk (CM)-FPIES. Skin testing is performed by 73.4%; 62.2% obtain serum food-specific IgE testing, 12.7% patch testing, 36.8% oral challenge, and 28% perform no tests. Eighty-four percent provide patients with FPIES with allergy action plans, 72.8% provide a personalized action plan, and 21% prescribe epinephrine autoinjectors. Odds of prescribing epinephrine were lower among those reporting “full understanding” of FPIES (odds ratio [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 oral food challenge (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 timing for food reintroduction. 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 one-third of respondents reported poor familiarity with FPIES. Considerable variation exists in the use of diagnostic tests, management, and choice of “safe” nutrition, indicating a strong need for FPIES practice guidelines.
AB - Background Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy. Objective To better understand provider-level variation in FPIES knowledge and management. Methods A 23-question online survey was administered to AAAAI members during the spring and summer of 2014. Results Among 470 respondents, 64% reported “full understanding” of FPIES diagnosis/management; 78.8% reported managing 1 or more patient with FPIES; and 80.4% correctly identified an FPIES case vignette. FPIES was correctly differentiated from infantile colic or food protein–induced allergic proctocolitis by 82.5% and 71.3%, respectively. Among providers currently managing patients with FPIES, 47.5% indicated soy formula, 73.8% breast milk, and 94.5% elemental formula as appropriate substitutes in cow milk (CM)-FPIES. Skin testing is performed by 73.4%; 62.2% obtain serum food-specific IgE testing, 12.7% patch testing, 36.8% oral challenge, and 28% perform no tests. Eighty-four percent provide patients with FPIES with allergy action plans, 72.8% provide a personalized action plan, and 21% prescribe epinephrine autoinjectors. Odds of prescribing epinephrine were lower among those reporting “full understanding” of FPIES (odds ratio [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 oral food challenge (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 timing for food reintroduction. 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 one-third of respondents reported poor familiarity with FPIES. Considerable variation exists in the use of diagnostic tests, management, and choice of “safe” nutrition, indicating a strong need for FPIES practice guidelines.
KW - AAAAI
KW - FPIES
KW - FPIES diagnosis
KW - FPIES knowledge
KW - FPIES management
KW - Provider awareness
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U2 - 10.1016/j.jaip.2016.11.036
DO - 10.1016/j.jaip.2016.11.036
M3 - Article
C2 - 28284784
AN - SCOPUS:85015680468
SN - 2213-2198
VL - 5
SP - 1319-1324.e12
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 5
ER -