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. 2023 Feb 10:4:1102410.
doi: 10.3389/falgy.2023.1102410. eCollection 2023.

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

Jennifer Pier  1 , Theresa Bingemann  1 , Jasdeep Badwal  1 , Daniel Rosloff  2 , Muhammad Pasha  2 , Hongyue Wang  3 , Jeanne M Lomas  1 , Kirsi M Järvinen  1
Affiliations

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

Jennifer Pier et al. Front Allergy. .

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 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 of demographics and the time to the diagnosis.

Results: In total, 110 patients with FPIES were identified. The median time to diagnosis was 3 months, vs. 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%). There was a statistically significant difference in race/ethnicity between the FPIES cohort and IgE-mediated food allergy group (p < 0.0001), with a greater proportion of Caucasian patients in FPIES vs. IgE-mediated food allergy cohort.

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.

Keywords: FPIES; food allergy; healthcare utilization; non-IgE mediated food allergy; vomiting.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Number of total referrals for evaluation in whom FPIES was diagnosed and number of those referrals specifically made for concern of FPIES from each specialty.
Figure 2
Figure 2
Identified FPIES trigger food and number of patients at each cohort. Other foods that were seen 2 or less patients included corn, meat (chicken, pork, beef, lamb), white potato, coconut, pear, apple, peanut, blueberry, chickpea, mango, cashew, carrot, cauliflower, sunflower, and watermelon.
Figure 3
Figure 3
Total number of FPIES trigger foods among the cohort..
Figure 4
Figure 4
Atopic and gastrointestinal co-morbid conditions among cohorts. AD: atopic dermatitis, Food allergy: IgE-mediated food allergy, GERD: gastrointestinal reflux disease, AR: allergic rhinitis, FPIAP: food protein-induced allergic proctocolitis, FPE: food protein-induced enteropathy.
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