AUTHOR=Pier Jennifer , Bingemann Theresa , Badwal Jasdeep , Rosloff Daniel , Pasha Muhammad , Wang Hongyue , Lomas Jeanne M. , Järvinen Kirsi M. 

TITLE=Food protein-induced enterocolitis syndrome: Healthcare utilization and referral patterns among a pediatric cohort

JOURNAL=Frontiers in Allergy

VOLUME=Volume 4 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/allergy/articles/10.3389/falgy.2023.1102410

DOI=10.3389/falgy.2023.1102410

ISSN=2673-6101

ABSTRACT=BACKGROUND: Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed, repetitive vomiting. FPIES is improving in recognition; however, there remains a lag in diagnosis. This study aimed to further explore this lag, as well as referral patterns and healthcare utilization, to help determine areas for earlier recognition.

METHODS: A retrospective chart review of pediatric FPIES patients at two hospital systems in New York was completed. Charts were reviewed for age of symptom onset/diagnosis, FPIES episodes and healthcare visits prior to diagnosis, and reason/source of referral to an allergist. A cohort of patients with IgE-mediated food allergy was reviewed for comparison. 

RESULTS: In total, 110 patients with FPIES were identified. The median length to diagnosis was 3 months, versus 2 months in IgE-mediated food allergy (p < 0.05). Most referrals were from the pediatrician (68%) or gastroenterology (28%), none were from the ED. The most common reason for referral was concern of IgE-mediated allergy (51%), followed by FPIES (35%). 

CONCLUSION: This study demonstrates a lag in the diagnosis of FPIES and a lack of recognition outside of the allergy community, as only one-third of patients were considered to have FPIES prior to an allergy evaluation.