Advanced search

Oral food challenges in FPIES: A narrative review and proposals for emergency and home-based management of acute FPIES reaction.

Virginie Jubin, Pascale Dumond, Grégoire Benoist, Flore Amat, Harriet Corvol, Laure Couderc-Kohen, Antoine Deschildre, Angélique Doc, Amandine Divaret-Chauveau, Kamal El Abd, Agnès Linglart, Carine Metz-Favre, Anne Hoppe, Karine Levieux, Martine Morisset, Frederic Valla, Sibylle Blanc, Anaïs Lemoine

Journal: Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2026;37(7):e70402

PMID: 42473072

View on PubMed

Abstract

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy marked by delayed vomiting and potential hypovolemic shock. This review by the French FPIES working group (SFA, GFRUP, Sp2A, SFP) analyzes recent literature on oral food challenges (OFC) adverse reactions and proposes a standardized protocol for OFC and emergency management. Early consensus OFC protocols from 2017 showed limitations-mainly short intervals between doses during OFC and high hospitalization burdens-leading to inconsistent practices. This narrative review of 2017-2025 studies shows that a single 25% age-appropriate portion generally suffices to trigger symptoms, typically within 1-4 h. This approach balances safety and feasibility while reducing hospital time. As part of the French FPIES monitoring register, and to easily apply this portion, the serving size for each food has been established with specialized dieticians. According to severity, acute reactions require prompt rehydration and ondansetron. Oral or sublingual ondansetron, effective for mild to moderate reactions, can limit dehydration and hospital transfers. In a hospital setting, oral rehydration is indicated in mild reactions, whereas vascular hydration (10 mL/kg over 5-20 min) is required for moderate to severe reactions. Corticosteroids may be added in severe cases. Adrenaline is unnecessary unless associated IgE-mediated symptoms are observed. The working group also proposes including oral rehydration solution and ondansetron in every home emergency kit. These proposals provide a national consensus on the management of FPIES by standardizing French practice from the OFC to the acute management of allergic reaction both in hospitals and at home.

© 2026 The Author(s). Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

Address: Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Cabinet médical Medilac, Le Bourget du Lac, France.; Hôpital Couple Enfant, La Tronche, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pôle Médical Saint Martin, Blénod-lès-Pont-à-Mousson, France.; Pediatric Allergy Department, Hôpital d'enfants, CHRU de Nancy, Vandoeuvre les Nancy, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Service de Pédiatrie Générale, HDJ Allergologie pédiatrique, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France.; Société Française d'Allergologie (SFA), Food Allergy working group, Montpellier, France.; Pediatric Pulmonology and Allergology Department, Robert Debré Hospital, AP-HP, Université Paris Cité, Paris, France.; INSERM 1018, Respiratory Integrative Epidemiology, Villejuif, France.; Société de Pneumologie et d'Allergologie Pédiatrique (SP2A), Paris, France.; Pediatric Pneumology, Hôpital Trousseau, AP-HP, Paris, France.; Sorbonne University, Inserm U938, Saint-Antoine Research Center (CRSA), Paris, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pédiatrie médicale et médecine de l'adolescent, CHU de Rouen, Rouen, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pediatric Pulmonology and Allergy Unit, CHU Lille - Jeanne de Flandre Hospital, University of Nord de France, Lille, France.; Univ. Lille, CNRS, Inserm, CHU Lille - Jeanne de Flandre Hospital, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France.; Société Française d'Allergologie (SFA), AllergoDiet working group, France.; Dietetician unit, CHRU de Besançon, Besançon, France.; Pediatric Allergy Department, Hôpital d'enfants, CHRU de Nancy, Vandoeuvre les Nancy, France.; Société Française d'Allergologie (SFA), Food Allergy working group, Montpellier, France.; UR 3450 DevAH, Health Faculty, Nancy, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pediatric Allergology Center, Department of Pediatrics, CHC MontLégia Clinic, Liège, Belgium.; Société Française de Pédiatrie (SFP), Paris, France.; Endocrinology and Diabetes for Children, Physiologie et Physiopathologie Endocriniennes, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre, Université Paris-Saclay, Inserm, AP-HP, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Allergy Division, Department of Chest Diseases, University Hospital, Strasbourg, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pediatric Pulmonology and Allergology Department, CHU d'Angers, Angers, France.; Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP), Paris, France.; Services d'urgences pédiatriques, CHU de Nantes, Nantes, France.; Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP), Paris, France.; Nutrition support team, Hospices Civils de Lyon, Lyon, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pediatric pneumology and allergology unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.; Société Française d'Allergologie (SFA), French FPIES working group, Montpellier, France.; Pediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France.; Sorbonne Université, Inserm, Nutrition et obésités: approches systémiques, Paris, France.; Gut, Liver & Microbiome Research (GLIMMER) FHU, Paris, France.; INRAE, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France.
DOI: 10.1111/pai.70402
MeSH Terms: Humans, Food Hypersensitivity, Enterocolitis, Fluid Therapy, Dietary Proteins, Ondansetron, Administration, Oral, Allergens
Bant logo

© Copyright 2026, Nutrition Evidence

NED wishes to thank the following organisations for their support:

Sponsor Sponsor Sponsor Sponsor Sponsor Sponsor Sponsor

We use cookies to improve your experience and analyze site traffic with Google Analytics. By continuing to use our site, you agree to our use of cookies. Learn more.