Pediatricians exhibited limited knowledge of food protein-induced enterocolitis

Many pediatricians are somewhat or completely unfamiliar with food protein-induced enterocolitis, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting in San Antonio.

Researchers randomly sent a 22-question, anonymous survey about food protein-induced enterocolitis (FPIES) to physicians registered as pediatricians with the AMA. Eighty-six physicians returned surveys that included questions about responders’ awareness of the illness, recognition of FPIES symptoms, and clinical vignettes requiring diagnosis.

Fifty-five percent of responders had practiced for longer than 15 years, 85% reported having a private office, and 67% reported practicing in a suburban area. One-fifth of responders indicated a full understanding of FPIES, 56% reported a limited understanding and 24% indicated they had never heard of FPIES. Seventy-three percent indicated that they had encountered patients with FPIES, and listed cow’s milk and concomitant milk and soy as the most commonly observed trigger foods. Gastroenterologists (57%) and allergists (32%) made the majority of FPIES diagnoses.

When asked about managing FPIES, 30% of physicians indicated oral rehydration and ED evaluation, 29% reported the use of epinephrine autoinjectors and 14% recommended oral steroids. The majority of responders (68%) referred patients with FPIES to a gastroenterologist, while 34% reported referrals to allergists and 39% indicated managing the condition themselves.

Evaluation of the clinical vignettes resulted in correct diagnosis of chronic FPIES in 73% of cases and acute FPIES in 53%. A misdiagnosis of FPIES was given for allergic proctocolitis by 58% of responders and for colic by 15%. Pediatricians were able to recognize severe diarrhea as an FPIES symptom most frequently (57%), followed by severe emesis (48%), failure to thrive (41%), hypotension (11%) and cyanosis and elevated WBC (9% each).

“Pediatricians have limited knowledge of manifestations and management of FPIES,” the researchers concluded. “There is a need for education and establishing a role of allergists in diagnosis and management of FPIES.”

For more information:

Menon N. #628: Knowledge of Food Protein-Induced Enterocolitis (FPIES) Among General Pediatricians. Presented at: The American Academy of Allergy, Asthma & Immunology Annual Meeting; Feb. 22-26, San Antonio.