FPIES (Food protein-induced enterocolitis syndrome)

Food protein-induced enterocolitis syndrome (FPIES) is considered as an unusual form of food allergy. It is uncommon than the IgE-mediated food allergy and typically occurs in babies and young children. FPIES is triggered by an allergic reaction to a particular food that causes inflammation of the small and large intestines. It is different from a usual food allergy based on the following:

  • It is a delayed reaction
  • Not triggered by the IgE antibodies
  • The symptoms are only limited to the gut
  • It is not linked with anaphylaxis, thus adrenaline is not used in managing a reaction

What are the symptoms?

Generally, the reaction starts around 2-4 hours after eating the trigger food. In most cases, the child will develop profuse sweating and frequently followed by diarrhea that can last for several days.

In severe cases of FPIES, there is diarrhea and vomiting that can lead to severe dehydration. The child will look pale, has a low body temperature and blood pressure during a reaction.

Remember that FPIES is not triggered by the IgE antibodies, thus children who experience the symptoms will not develop itchy, swollen skin, facial swelling or rashes. Nevertheless, it is possible for a child with FPIES to have other allergies including food allergies which involve the IgE antibodies.

FPIES

The symptoms are only limited to the gut.

Oftentimes, children with FPIES experience mild reactions and if they continue to eat the trigger foods, the allergy can result to poor growth.

Possible foods that can trigger FPIES

The common triggers include cow’s milk and soy. On the other hand, almost any food can trigger a reaction including cereals, rice, certain vegetables and meats such as turkey and chicken. Some children have FPIES to more than one food protein.

How FPIES is diagnosed

At the present, there is no allergy test that can confirm a diagnosis of FPIES. Skin tests and blood tests to measure the IgE levels will not help since the reaction is not triggered by the IgE antibody.

The doctor will recommend an oral food challenge when the history is not clear or if foods from a similar food group are being introduced into the diet of a child who has FPIES.

Treatment

The only treatment for FPIES is to avoid the trigger food. The doctor will advise on how to modify the diet to achieve this and a dietitian should be consulted if the foods to be removed include a major food group.

There is no specific treatment for a child during an FPIES reaction. Nevertheless, they often respond to IV fluids due to the dehydration.

How FPIES resolves

Many children outgrow FPIES by the time they are about 3-4 years of age. The ideal way to determine whether a child has outgrown the condition is to undergo an oral food challenge. This should be done under the supervision of a specialist in a hospital setting.

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