A retrospective study found that the nausea and vomiting preventative treatment, ondansetron, was more effective than traditional therapy in inducing remission of vomiting in patients with acute food protein induced enterocolitis syndrome (FPIES).

Acute FPIES, a  non-IgE-mediated allergy, typically occurs 1–4 hours after ingestion of a triggering food and is characterized by repetitive vomiting episodes in addition to pallor, lethargy and diarrhea.  Researchers examined pediatric FPIES cases from the University of Sacred Heart (Rome, Italy) and Children’s Hospital at Westmead (Sydney, Australia) over a two year period. To be included in the study, all cases had to have patients who had an in-hospital reaction to a medically-supervised oral food challenge (OFC).

In total, 66 patients were included with an average age of 24 months (range 4 months–14 years, standard deviation [SD] 23 months). Thirty-seven patients received parenteral ondansetron, while 14 were treated with traditional therapy (IV boluses of saline solution and methylprednisolone), and 15 received no pharmacological therapy. 

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There was a significant reduction in vomiting episodes for the ondansetron treated group with just 19% continuing to vomit after therapy administration, compared to 93% of those treated with traditional therapy (P<0.05, relative risk [RR] = 0.2); the RR of 0.2, in favor of the ondansetron group, makes it highly unlikely these results were due to bias. Compared to those in the traditional therapy group, patients who received ondansetron treatment or no treatment were less likely to be admitted to the hospital overnight (P<0.05).

Patient treated in Rome received ondansetron intramuscularly, while those in Sydney were administered the drug intravenously. Analysis of these administration techniques showed no statistically significant differences.  

The author’s asserted, “Our study is sufficient to suggest the use of ondansetron for a situation for which, for now, there are no proven effective therapeutic alternatives.”

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