{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:03:42Z","timestamp":1789542222498,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Oral food challenge (OFC) protocols in food protein\u2010induced enterocolitis syndrome (FPIES) often select starting doses with consideration of prior reaction severity, implying that dose may influence reaction intensity; however, patient\u2010level evidence linking antigen dose to reaction profiles remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To characterize threshold heterogeneity and compare clinical reaction profiles between diagnostic and reactive threshold OFCs within individual patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this prospective study, 54 infants with OFC\u2010confirmed FPIES (egg yolk, 36; cow's milk, 18) underwent threshold characterization at 0.001\u2009g\/kg (ultra\u2010low) and 0.01\u2009g\/kg (low); all had previously reacted at a diagnostic OFC (median 0.38\u2009g\/kg). For the 30 reacting at a threshold challenge, the primary endpoint was objective reaction intensity (vomiting, examination signs); treatment intensity and a composite burden category were supporting measures.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 54 patients, 12 (22%) reacted at 0.001\u2009g\/kg, 18 (33%) at 0.01\u2009g\/kg, and 24 (44%) tolerated both. Among the 30 threshold reactors, reactions were objectively milder than at the diagnostic OFC: median vomiting 2 (IQR 2\u20133) versus 4 (4\u20136) (\n p<\/jats:italic>\n \u2009<\u2009.001), pallor 27% versus 63% (\n p<\/jats:italic>\n \u2009=\u2009.019), decreased activity 43% versus 80% (\n p<\/jats:italic>\n \u2009=\u2009.007). No ICG\u2010defined severe features (hypotension\/shock, severe lethargy) occurred at either OFC. Treatment intensity was also lower (intravenous fluid and prolonged observation each 27% versus 67%; both\n p<\/jats:italic>\n \u2009<\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Reactions at ultra\u2010low and low threshold doses were objectively milder than at diagnostic doses within patients, while clinically meaningful reactions still occurred. These findings support systematic threshold assessment beginning at 0.001\u2009g\/kg, independent of diagnostic OFC clinical burden.<\/jats:p>\n \n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pai.70463","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:06:45Z","timestamp":1786957605000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Threshold heterogeneity and dose\u2010related clinical reaction profiles in infantile food protein\u2010induced enterocolitis syndrome"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6861-1559","authenticated-orcid":false,"given":"Yosuke","family":"Baba","sequence":"first","affiliation":[{"name":"Department of Pediatrics Juntendo University Shizuoka Hospital Izunokuni Shizuoka 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