Ondansetron in Acute Food Protein-Induced Enterocolitis Syndrome, A Retrospective Case-Control Study

Abstract

This study looked at the effectiveness of parenteral ondansetron in resolving acute symptoms of food protein–induced enterocolitis syndrome (FPIES).This study examined patients aged 4 months to 14 years with a positive oral food challenge (OFC) for FPIES.This was a retrospective case series of OFCs done to either definitively diagnose FPIES or to assess for the resolution of FPIES. Positive challenges were defined as those that induced a reaction of vomiting within 0.5–6 hours of ingestion without cutaneous or respiratory symptoms suggestive of an IgE-mediated reaction. Treatment was categorized as traditional (normal saline IV bolus and methylprednisolone), ondansetron, or no therapy. Therapeutic success was defined as cessation of vomiting.Sixty-six patients were included; 37 received ondansetron, 14 received traditional therapy, and 15 received no therapy. Nineteen percent of children in the ondansetron group continued to vomit compared with 93% in the traditional therapy group.Parenteral ondansetron is significantly more effective than traditional therapy in resolving symptoms of FPIES. The findings suggest an effective treatment of vomiting in positive FPIES OFCs and allow for more confidence in performing OFCs.Food protein–induced enterocolitis is a non-IgE–mediated allergic disease of early childhood characterized by repetitive, profuse vomiting episodes and presenting within 1 to 4 hours of ingesting a triggering food. Cow’s milk, soy, grains, egg, and fish are among the most common triggers. The diagnosis is primarily made through clinical history. While the pathophysiologic mechanism of the disease is not completely known, this study confirms prior research that ondansetron plays an important role in terminating episodes of FPIES reactions. The diagnosis of FPIES should be considered among patients with recurrent vomiting from triggering foods. Ondansetron can be used as a first-line therapy in the treatment of FPIES episodes because it was shown in this study to terminate vomiting episodes and resolve and lethargy.