The prevalence of food protein-induced enterocolitis syndrome (FPIES) to avocado consumption appears to be higher than previously believed, according to results of a recent study.

FPIES is a gastrointestinal food-associated hypersensitivity that often affects infants and toddlers and is marked by vomiting, diarrhea, fatigue, and pallor. Data regarding its incidence is limited however, is estimated to be 1.5 to 30 per 10,000. Although avocado is considered to be a low-risk food according to international consensus guidelines, recent data may prove otherwise. 

“We report a perceived higher prevalence of FPIES to avocado, with 3 out of 14 FPIES patients presenting to a single provider in NYC over a 12-month period reporting FPIES reactions with avocado,” write the authors. In these 3 cases, 6- to 8-month old patients developed repetitive vomiting 1-4 hours after ingestion of avocado and two experienced symptom recurrence following repeat exposures.

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“Among pediatricians referring to the center’s practice, avocado is often suggested as one of the first weaning foods; the enrichment of this population with patients who are frequently exposed to avocado at young ages may explain the increased prevalence noted in this center’s patients,” the authors explained. 

According to guidelines, patients who experience FPIES should be offered nutritional counseling and provided a list of low-risk foods that should be introduced at home.

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Based on the cases presented in this paper, the authors concluded that FPIES reactions with avocado appear to be more common than originally believed. “Knowledge of avocado as a potentially emerging trigger will aid timely diagnosis and guide complementary food introductions.”


Goodman M, Feuille E. Avocado: An emerging culprit in food protein-induced enterocolitis syndrome?. Annals of Allergy, Asthma & Immunology. 2018,

This article originally appeared on MPR