A Second Slice of FPIES: A Single Center Reappraisal of Pediatric FPIES

Background Food protein-induced enterocolitis syndrome (FPIES) is being increasingly recognized as a non-IgE mediated food allergy; however, it remains unclear if and how the presentation, diagnosis and management of this disease has changed in recent years. Objective To reappraise the FPIES cohort at a large United States pediatric tertiary referral center. Methods We performed a retrospective chart review of pediatric FPIES patients (ICD-10: K52.21) diagnosed in our allergy/immunology clinics between 2018-2022. Results There were 210 children diagnosed with FPIES. Most were White (73.8%), non-Hispanic (71.4%) and male (54.3%) with private insurance (77.6%). Cow’s milk was the most common food trigger (35.2%) with the earliest median age of onset of 5 months. The atypical FPIES rate was 13.8%. FPIES was accurately diagnosed in 54.3% at the first medical contact. The oral food challenge pass rate was 73.5%. The rate of trigger resolution at 36 months was 77%. Conclusion By comparing trends from a previous and current FPIES cohort, we were able to assess the potential impact of various guidelines and practice changes on the diagnosis and management of FPIES at our center. Milk and oat surpassed rice as the most common FPIES triggers; peanut and egg emerged as new FPIES triggers; there was a shorter time to diagnosis and an increased rate of atypical FPIES. Our findings reflect earlier recognition of FPIES and prompt allergy/immunology referral from community physicians, implementation of recent medical society guidelines for infant feeding practices and growing clinical expertise of allergists at our center.