Trends in Provider Management of Patients with Food Protein-Induced Enterocolitis Syndrome

Matthew Greenhawt, J. Andrew Bird, Anna H. Nowak-Wegrzyn

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StateAccepted/In press - Jan 22 2016

Fingerprint

Enterocolitis
Food
Proteins
Odds Ratio
Milk Proteins
Epinephrine
Proctocolitis
Knowledge Management

Keywords

  • AAAAI
  • FPIES
  • FPIES diagnosis
  • FPIES knowledge
  • FPIES management
  • Provider awareness

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Trends in Provider Management of Patients with Food Protein-Induced Enterocolitis Syndrome. / Greenhawt, Matthew; Bird, J. Andrew; Nowak-Wegrzyn, Anna H.

In: Journal of Allergy and Clinical Immunology: In Practice, 22.01.2016.

Research output: Contribution to journalArticle

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abstract = "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.",
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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.

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