title: Trends in Provider Management of Patients with Food Protein-Induced Enterocolitis Syndrome.
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.
authors.affiliation: The Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo; University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Matthew.Greenhawt@childrenscolorado.org.
authors.forename: Matthew
authors.initials: M
authors.lastname: Greenhawt
authors.affiliation: Food Allergy Center at Children's Medical Center, Dallas, Texas.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bird
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY; Jaffe Family Food Allergy Institute, New York, NY.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Nowak-Węgrzyn
mesh_terms: D000046:Academic Medical Centers; D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004044:Dietary Proteins / Q000276:immunology; D004760:Enterocolitis / Q000175:diagnosis* / Q000628:therapy; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000628:therapy; D006282:Health Personnel; D006801:Humans; D007114:Immunization; D011795:Surveys and Questionnaires; D013577:Syndrome
chemical_list: D000485:Allergens; D004044:Dietary Proteins
keywords: AAAAI; FPIES; FPIES diagnosis; FPIES knowledge; FPIES management; Provider awareness