Rotation Diet, Protein Intolerance and FPIES?

FPIES is on the spectrum of Protein Intolerance.   Much like typical IgE allergy has a spectrum of reactions, from a scratchy throat, to flushing, to hives all the way to anaphylaxis.   FPIES is anaphylaxis of the gut.  It is a severe protein intolerance.   And, just as with typical allergies....some kids have just one IgE allergy and some have multiple.   With Protein intolerance's, some kids have just one (milk or soy or milk and soy- referred to as MSPI) but many kids have multiple intolerance's.   With FPIES, some kids have just one trigger- milk or soy, or rice and oats; but again many have multiple.   And then still, many kids have all 3- Protein Intolerance, FPIES, and IgE allergies.   The bridge where they all cross can be confusing.  

With protein intolerance's, you may be able to have a food if it is cooked or the oils or in low threshold amounts- the body can "cope".    Protein intolerance kids can often also handle a rotation diet.  A rotation diet can avoid a "build up" of the proteins while still keeping the foods in the diet for their nutritional value, and while also building up the bodies tolerance of the food- training it, with each small incremental dose that the food is foreign but safe.  With each dose, the body building more tolerance mechanism and less attacking mechanisms.

My question remains: is this safe in the FPIES child?   The FPIES child with protein intolerance that the body is already primed for FPIES trigger attack mechanisms.   Is the body so efficient at producing those mechanisms of attack...mechanisms designed for protection against viruses and toxins but attacking simple food proteins in the FPIES child....that every intolerance is vulnerable for FPIES? 

It is not possible to include known triggers in a rotation diet, but could it work for trialing foods?   Little man seems to build up intolerance's to foods at day 3-4 (or beyond); his body recognizes it as unsafe almost immediately (we can always look back at logs and see in hindsight that nothing was coincidental, that all symptoms eventually led to something) but we press through because we can't fail a food at the first signs of hiccups, or irritability or some disturbed sleep....when all these things can just be a coincidence and we would have no menu!   And yet, none of those symptoms have ever been a coincidence, and his intolerance's build until we have to pull the food as it is unsafe, causing too many off-baseline symptoms or behaviors, or it has caused a trigger reaction.   It would be unsafe to keep a food in the diet (even in rotation) if it is causing symptoms of off-baseline because the waters would get really muddy -- how would we know which foods were causing which symptoms and which foods are building symptoms and which ones are causing 'just' adjustment symptoms?  

With an FPIES diagnosis, you are given a set of instructions for food trials at home, there are variances to these schedules but they are all similar in that they are small doses over long periods of time.   The reasoning behind the slow introductions is to stop before the symptoms build to the full blown fail....the tricky part is finding that line of "are these build symptoms" or "are these body adjustment and/or intolerance symptoms?" Keeping a food and symptoms log has been essential for this; although many FPIES children react from the first dose of the food trial.   A second reasoning behind the slow introductions for protein intolerance is to teach the body "foreign but safe".

My goal has been, of course, to do this for Little Man.   To introduce foods in his diet (in his muffins that he enjoys so much would be ideal)  slowly, 1 tsp at a time....to build his tolerance while monitoring closely for symptoms. BUT- without a base diet first, or with missing micro nutrients....we aren't at that place yet to be able to execute this ideal FPIES scenario for food introductions.  

So, that got me to thinking about a rotation diet- would a rotation diet of trial foods help us to teach his body foreign but safe without overwhelming it and pushing him past his tolerance levels?   Would it make it less daunting to take breaks from a food beginning to cause symptoms?   Little man seems to do ok with foods for the first 1-3days, and then intolerance's really begin to add up.  Is this because they are closely related to the proteins he has had reactions to (grains and dairy?).   This is why I have been picking foods he hasn't ever had before, or that aren't related to his FPIES triggers.    Millet is a seed but it is in the cereals food family so we were taking a risk on it.    Millet is still a mystery.

To execute a rotation diet, it would need to be closely calculated out  - trial a food for 2-4days, give the body a break (3-5days)- reintroduce....teaching the body- foreign but safe (building the Th3 response to override the Th1 response mechanisms?). Similar to oral immunotherapy that is being found successful for some allergies?

A few important FPIES considerations:
1. It would be critical to not go too long between re-exposures or the body will 'forget' it's tolerance mechanisms.
2. Also critical to not push if reaction symptoms persist or build (body is building attack/Th1 mechanisms instead of oral tolerance/Th3). 
3.  Essential to stay at dose tolerated (or less) if symptoms begin to build.
4. To return to ONLY safe base diet during the "break" if there are any off-baseline symptoms noted (and not rotate to new trialed food). 

In my head, on paper, this works....with Little man it hasn't, yet....