Food protein‐induced enterocolitis syndrome (FPIES) is a non‐Immunoglobulin (non‐IgE)‐mediated food allergy. The elimination diet is the only therapy, the culprit food will be reintroduced if tolerance is acquired. However, it is possible that patients do not follow the recommendations given by the healthcare professional. We investigated if our advice to avoid the trigger food in patients with active FPIES and to reintroduce it in the diet in patients who achieved tolerance had been implemented. We interviewed by telephone the parents of children who were diagnosed with acute FPIES. About 23.2% of our patients disregarded our dietary recommendations: 6/42 (14.3%) of patients who passed a tolerance oral food challenge (OFC) did not eat the trigger food, 4/22 (18.2%) of patients who failed OFC ate the trigger food, and 9/18 (50.0%) of patients who did not perform a tolerance OFC ate the trigger food. We have analyzed some possible influencing factors and no difference was found to be statistically significant. Our results are in line with those reported for IgE‐mediated food allergies. As has already been proposed by others, we suggest reassessing food consumption in all patients after a food challenge.

We report on a paediatric patient that presents simultaneously a food allergy (FA) with clinical manifestations of both food protein-induced enterocolitis syndrome (FPIES) and IgE-mediated FA to cow’s milk and a classic non-IgE-mediated FPIES to peanut. This has implications from both a speculative and a clinical point of view. Indeed, we do not consider it sufficient to define FPIES as a non-IgE-mediated FA. There are numerous indications that suggest a role for IgE in at least some patients. Therefore, we would prefer it to be classified as a mixed form. Some patients, such as the one described in our paper, are definable as ‘in the middle of the ford’. From a clinical point of view, the identification of a role for specific IgE could hypothetically facilitate the choice of certain dietary indications, such as testing tolerance to processed cow’s milk derivatives.

Title:Comment on Halken et alAuthors :Stefano Miceli Sopo a, Dario Sinattia, Francesco Mastellone b, Giulia Bersani a, Mariannita Gelsomino b.