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.

To the Editor:Food-induced anaphylaxis is occurring more frequently in response to composite foods where the culprit may be a contaminant.1 A few published case reports describe anaphylactic reactions in patients after consuming foods contaminated with mold. One patient died after consuming mold-contaminated pancake mix.2 Another experienced a non-life threatening anaphylactic reaction to mold-contaminated bee-pollen.3 A case of true anaphylaxis occurred after a patient consumed dry cured meat products that require mold in their preparation.4 Quorn, a meat substitute made with mycoprotein, caused a lethal anaphylactic reaction in a pediatric patient with a previously known mold allergy.5Multiple reports on the internet and news outlets have described parents finding mold in preservative-free juice drinks, but no reports have described allergic reactions.