It's been a while since Myra has had a reaction during a food trial, 10 months to be exact. When Niko was born, we chose some foods with a really high pass rate to trial so we could continue adding to her diet without setting ourselves up for failure with a newborn in the house. As we have tiptoed into some riskier foods and still been blessed to not have any reactions, we have also loosened up our trial method. I was fortunate to find another FPIES mom, Jamie V, who has done plenty of research and trial and error of her own and used her wisdom in figuring out which foods to trial. Now, I am using her same method for the trial itself. Originally, we could trial one new food every 14 days. With this method, we are able to trial two new foods every 20 days. The big caveat is that it only works if everything is going well. Thankfully, that has been the case for quite some time now.
Click here to see how we used to run trials.
The combination of not having a reaction for a long time, Myra having great communication skills so she can tell us if she isn't feeling well, and not having any unique circumstances lately like teething or illness is what makes us able to do a faster paced trial. As a reminder, the important aspects of a trial for us are to start slowly yet build to a full serving size, take a break, then come back to the food while starting slowly and building to a full serving size again. Many FPIES kiddos don't react to a food until they have a break from it, so that is an important part of our trial. This is the new method that has been working well for us.
New food #1 for 5 days (working up to a full serving size by day 5)
New food #2 for 5 days (working up to a full serving size by day 5)
Back to new food #1 for 5 days (working up to a full serving size by day 5)
Back to new food #2 for 5 days (working up to a full serving size by day 5)
If all goes well by the end of the second five-day period, we consider that food a pass. This allows us to take advantage of the break rather than just letting time pass. If we see or even suspect a reaction, though, we can't introduce the second food during the break. In that case, we would use the break to see if the symptom goes away or if it is unrelated (teeth, illness, seasonal allergies, etc.). It is much easier now that Myra can tell us what is bothering her. She was struggling with sleep for a while which was our first red flag, but now she is able to tell me that her "nose feels yucky and her eyes feel ouch" which was my indicator to get her Zyrtec refilled.
I wouldn't feel comfortable doing two risky foods in the same trial period, just to be safe. For example, we wanted to do peanuts and wheat. Peanuts aren't quite as risky for FPIES kids, but because it is a legume like soy, green beans, and peas (all fails for Myra) we were nervous. Had one or the other gone bad, we wouldn't want to risk confusion between the two or derailing the whole trial, so we paired each with a less risky option.