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Knowledge of Food Protein-Induced Enterocolitis (FPIES) Among General Pediatricians

      Rationale

      FPIES is a non-IgE, presumably T cell-mediated gastrointestinal childhood food allergy that manifests within 2-4 hours following food ingestion with repetitive emesis, ashen-gray appearance and lethargy; 15% progress to hypotension. We sought to determine knowledge of FPIES among pediatricians.

      Methods

      A 22-question anonymous survey was sent via email to randomly selected physicians who registered with American Medical Association (AMA) as pediatricians.

      Results

      Eighty-six surveys were completed; 55% responders were in practice more that 15 years, 67% in suburban location and 85% in private office. Twenty percent declared full understanding, 56% limited understanding of FPIES; 24% never heard of FPIES. When presented with clinical vignettes, 73% recognized chronic FPIES, 53% recognized acute FPIES; 58% misdiagnosed allergic proctocolitis and 15% colic as FPIES. Recognition of specific FPIES symptoms was as follows: severe diarrhea 57%, severe emesis 48%, failure to thrive 41%, hypotension 11%, cyanosis 9%, and elevated WBC 9%. Seventy-three percent reported having patients with FPIES in their practice, with most common triggers being cow’s milk, followed by concomitant milk and soy. Diagnosis was made by a gastroenterologist in 57% and allergist in 32%. Regarding management of acute FPIES, 30% recommended oral rehydration at home followed by emergency room evaluation, 29% prescribed epinephrine autoinjector, and 14% prescribed oral steroids. 39% reported managing FPIES by themselves, 68% referred out to a gastroenterologist and 34% to an allergist.

      Conclusions

      Pediatricians have limited knowledge of manifestations and management of FPIES. There is a need for education and establishing a role of allergists in diagnosis and management of FPIES.