How are you diagnosing chronic FPIES in adults?

Primarily through patient history; delayed onset of GI symptoms, shellfish is a common culprit in adults with acute FPIES. It is hard to differentiate chronic FPIES from intolerance since there is limited pathophysiology on non-IgE mediated mechanisms. Limited role for challenge if history is convincing and most adults insist on strict avoidance after bad experiences. If any ambiguity regarding the time of onset between an immediate vs delayed onset can offer skin/sIgE tests. If there is no clea...