Adult Food Protein-Induced Enterocolitis Syndrome: A Review of Emerging Evidence and Clinical Considerations.

backgroundFood protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated reaction to food, well known in the allergy and immunology literature, that presents with delayed gastrointestinal symptoms. It is classically diagnosed in children and infants; however, new-onset cases have recently been identified in the adult population. SUMMARY: There is a paucity of literature on FPIES in the gastroenterology literature. This review aimed to bring awareness to this entity as a possible etiology of gastrointestinal symptoms. Symptoms include abdominal pain, diarrhea, repetitive vomiting, and nausea, which occur 1 to 4 h after initial ingestion of food. In adult-onset cases, food triggers most often include seafood (fish, crustacean, and mollusk). Egg, wheat, and cow's milk have also been identified as triggers for adult-onset FPIES. Oral food challenge is the gold standard for diagnosis. KEY MESSAGES: This review provides an overview of the current literature on adult-onset FPIES. Adult and pediatric patients notably have different presentations of FPIES and different triggers. Providers should be aware of these distinctions when diagnosing this condition.