BACKGROUND: Food protein–induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed, repetitive vomiting. FPIES has gained attention over the last few years and is becoming better recognized; however, there remains a lag in diagnosis. This study aimed to further explore this lag in diagnosis, as well as referral patterns and healthcare utilization, to determine areas for earlier recognition. METHODS: Data was obtained through retrospective chart reviews of pediatric FPIES patients at two hospital systems in New York. Charts were reviewed for age of symptom onset, age of diagnosis, FPIES episodes and healthcare visits prior to diagnosis, and reason/source of referral to allergy. 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, compared to 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 of FPIES outside of the allergy community, as only one-third of the patients were considered to have FPIES prior to an allergy evaluation. Patients with profuse, repetitive vomiting 1- 4 hours after food ingestion, especially of common FPIES trigger foods, should be considered for diagnosis of FPIES, as these encounters provide an opportunity for early recognition.