Food Protein-Induced Enterocolitis Syndrome (FPIES)
What is FPIES?
Food protein-induced enterocolitis syndrome (FPIES) is a rare type of delayed allergic reaction to food. FPIES doesn’t typically involve immunoglobulin-E (or IgE), which are the antibodies that cause classic food allergy symptoms like hives, swelling, and wheezing that you might see with allergic reactions to peanuts, egg, tree nuts. Instead, FPIES is thought to be triggered by specific cells in the immune system.
- Food Protein-Induced means that a food “triggers” a reaction.
- Enterocolitis means the colon or GI tract can become inflamed when exposed to a trigger food(s). This can lead to symptoms such as vomiting and diarrhea.
- Syndrome means a condition with a common group of symptoms with severity varying from person to person.
Common foods that can trigger a reaction include cow’s milk, soy, shellfish, and grains, like rice, oats, and barley. Other foods that can cause this reaction include egg, peanut, meat, vegetables, tree nuts, seeds, and poultry (chicken and turkey).
While some foods are more likely to trigger an FPIES reaction, it may be caused by any food protein. FPIES in older children and adults is most often caused by seafood.
How common is FPIES?
FPIES most often occurs in infancy but may also happen in older children and adults. In the U.S. it is estimated that 5 in 1000 children and 2 in 1000 adults have FPIES. That means about 900,000 people suffer from FPIES in the U.S.
While FPIES can develop in adults, it usually starts during the first year of life when infants start eating solid foods or formula. Most children outgrow FPIES by 3 to 4 years of age.
What are the signs and symptoms of FPIES?
The most common symptoms of FPIES include repeated vomiting and diarrhea that usually starts 1 to 4 hours after eating a triggering food. Other symptoms can include sleepiness, floppiness in infants, and paleness. Weight loss and failure to thrive can occur in some cases.
About 15% to 20% of reactions include severe dehydration, change in body temperature, and low blood pressure. FPIES symptoms do not usually include rashes and breathing problems.
How is FPIES diagnosed?
FPIES is not a well-recognized condition. Diagnosis can be hard because the symptoms often look like other conditions such as bacterial or viral infections. Although FPIES is an allergy, it cannot be detected through the usual skin prick or blood tests used to identify IgE-mediated food allergies. There are no tests that can tell for sure if you have FPIES.
Diagnosis is usually made after a clinician does a detailed medical history and a careful physical exam. A consultation with a board-certified allergy and immunology specialist can be very helpful. A doctor-supervised oral food challenge (OFC) may be needed to confirm an FPIES diagnosis. An OFC test can also be helpful in knowing if a person has outgrown the disease.
Are there any treatments for FPIES?
There is currently no cure for FPIES. Identification and strict avoidance of the trigger food(s) are keys to FPIES management. Medicines to treat nausea and vomiting, such as ondansetron, are usually recommended and can be very effective. The risks and benefits of medication should be discussed with your doctor.
Maintaining hydration (getting enough fluids) is important. In some severe cases intravenous hydration may be used.
Steroid treatments may also be used to lessen an immune reaction. Sometimes hospitalization is needed.
A written emergency treatment plan that outlines the symptoms and treatment of acute FPIES can be very helpful for patients and caregivers.
https://www.sciencedirect.com/science/article/pii/S1323893024000078