Food protein–induced enterocolitis syndrome in the US population–based study

To the Editor: Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE, cell-mediated food allergy that manifests with repetitive, projectile vomiting within 1 to 4 hours of food ingestion, frequently accompanied by pallor and lethargy and may be followed by diarrhea within 6 to 8 hours.1 In about 15% to 20% of the reactions, severe dehydration with hypotension and metabolic derangements is present.1 FPIES diagnosis may be delayed because of the severity, delayed onset of symptoms, and lack of cutaneous and respiratory manifestations (eg, hives and wheezing), typically associated with IgE-mediated food allergy, and food triggers considered to have low allergenic potential, for example, rice, oat, fruits, and vegetables. [...]we analyzed the reported physician-diagnosed food allergy (IgE-mediated, IgE-food allergy), asthma, atopic dermatitis, and allergic rhinitis as per the definitions published previously.7-9 Eligible study participants included adults (≥18 years) able to complete the survey in English or Spanish via web or telephone, who resided in a US household. [...]it is possible that FPIES diagnosis was used incorrectly because of the poor familiarity of the physicians with FPIES and led to underestimation or overestimation of true FPIES prevalence. Reported physician-diagnosed current or past FPIES Prevalence estimate (95% CI) All ages (N = 374) 0.28 (0.24-0.33) Children Age < 18 y (N = 261) 0.51 (0.42-0.62)