Reply to “Oral food challenge protocol for food protein-induced enterocolitis syndrome: time for a change?”

To the Editor: We would like to thank Barni et al for their comments.1 Food protein–induced enterocolitis (FPIES) is a non–IgE-mediated food allergy in which infants and toddlers present with delayed vomiting with or without diarrhea, 15% in shock.2 There is currently no biomarker to aide in diagnosis, no biomarker to aide in determination of causative food(s), and no biomarker to assess when one has outgrown the allergy. In 2017, the International Guidelines on FPIES were published.2 Within the guidelines, a suggested FPIES OFC protocol based on literature at that time was described (administer challenged food at a dose of 0.06 to 0.6 g/kg of body weight divided into 3 equal doses over 30 minutes, often followed by a full serving 2 to 3 hours later with a second observation period). In 2019, Barni et al4 published their experience with a modified FPIES OFC protocol in which patients were given the initial dose equivalent to 25% serving size, followed by a 4-hour observation period, and those who did not react received the remaining 75% serving size followed by an additional 4-hour observation period.