Hard to digest: The adult food protein-induced enterocolitis syndrome experience

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that is increasingly recognized in adults. Adult FPIES is characterized by severe abdominal pain, diarrhea and possibly vomiting. Pathophysiology and management between adults and children appear to be similar. However, with the evolving literature, distinguishing characteristics from pediatric populations have been identified, including gastrointestinal symptom profile, symptom severity, common food triggers, and female demographic predominance. Despite the growing body of data on adult FPIES, there remain significant challenges related to diagnosis due to the broad differential diagnosis, poor awareness, and lack of confirmatory testing aside from oral food challenges. There is significant heterogeneity in the literature regarding the best protocol for oral food challenges in adult FPIES. There also remain limitations in understanding prognosis, natural history, and factors affecting tolerance. These limitations have been reflected in reported unmet needs, with consequences on quality of life for adults diagnosed with FPIES. This review focuses on the most recent literature regarding clinical presentation, epidemiology, pathophysiology, management, and unmet needs for adult FPIES, with discussion of areas requiring further investigation.