Food Protein Induced Enterocolitis Syndrom (FPIES)

Food Protein Induced Enterocolitis Syndrome (FPIES) is not your typical food allergy and is most often found in infants and young children presenting within the first weeks or months of life, but at an older age for children that are exclusively breastfed. These reactions occur when solid foods such as cereals or formulas are introduced to the child’s diet. FPIES is a food allergy that affects both the large and small intestine of the gastrointestinal system, causing inflammation that leads to projectile vomiting and bloody diarrhea. These symptoms may eventually lead to dehydration and eventually shock after eating one of the two most common trigger foods; dairy and soy. In the most severe cases, 20% of the afflicted children are rushed to the emergency room for intervention as the reactions are severe and obviously life threatening if left unattended. More often than not, parents are told that it’s a just a stomach virus, given fluids, and sent home. FPIES may take anywhere from 2-8 hours to exhibit the first symptoms, which range from an increase in reflux and several days of runny stools to shock. These symptoms may last for several days.

FPIES is a Cell Mediated (delayed) immune reaction from common foods and is not considered an actual allergic reaction. Actual food allergies are IgE Mediated or immediate and show symptoms such as itching,hives, swelling, coughing or difficulty breathing. Since FPIES is a non-IgE mediated immune reaction, children who have FPIES do not make allergic antibodies against the trigger food, rendering food allergy tests useless and FPIES difficult to diagnose.

FPIES does not negate other types of food allergies or intolerances a child may experience. The most common foods that trigger a Food Protein Induced Enterocolitis episode are cow’s milk (dairy) and soy. However it has been noted that some of the less common allergens as rice, oat and barley can also cause a reaction. Additional common trigger foods are: green beans, peas, sweet potatoes, squash, chicken and turkey. A reaction to one does not necessarily mean that there will be a reaction to all common foods. These are the most prevalent trigger foods, however be mindful that any food, even in trace amounts, has the ability to set off an FPIES episode.

Dealing with an FPIES reaction varies from patient to patient and is specific to each individual’s situation. Rapid dehydration and shock are medical emergencies that require intravenous (IV) fluids. Some symptoms can be so severe that administering of steroids and in-hospital monitoring is necessary. More mild episodes might be able to be treated at home with oral electrolyte re-hydration. Due to the fact that FPIES is a non-IgE mediated response, epinephrine is useless in treatment. Continued health management of an FPIES child includes a change in formula from dairy and soy based to hypoallergenic or elemental formulas and avoiding the offending food(s) completely. New foods are usually introduced very slowly, one food at a time for up to three weeks before another food is introduced into the diet.Many children outgrow FPIES by the age of three.

In June, 2013 the Centers For Disease Control (CDC) approved a new International Classification of Diseases code to help doctors identify this syndrome. This code will take effect in October 2015. Researchers will be able to study how common FPIES is and locate patients who can participate in prevalent studies. These studies will aid researchers in finding better treatments.

by Julianne La Porte, Co-Founder, CanIEatHere.com | November 20, 2013

Sources

Food Protein-Induced Enterocolitis Syndrome.
http://allergies.about.com/od/foodallergies/a/fpies.htm

Frequently Asked Questions about FPIES.
http://www.kidswithfoodallergies.org/resourcespre.php?id=99

What is Food Protein Induced Enterocolitis Syndrome?
http://www.iaffpe.org/what_is_fpies.html