If your child has been diagnosed with food protein-induced enterocolitis syndrome (FPIES), it’s normal to feel overwhelmed. Witnessing an FPIES reaction for the first time can be incredibly scary, no matter what age your child is. FPIES is a rare food allergy that mostly affects infants and young children, but can sometimes affect older children and even adults. If you want to know more about this food allergy, here’s a beginner’s guide to FPIES.
What is FPIES?
FPIES is a delayed food allergic reaction affecting the gastrointestinal tract. Unlike typical food allergies, FPIES symptoms do not occur immediately after eating, but it usually takes two to four hours to see a reaction. FPIES most commonly occurs in children between the ages of six months to two years, however, in rare cases, it can begin in older children and even adults. Children with FPIES commonly have other family members with an allergic disease. FPIES may also be associated with atopic conditions such as eczema, asthma, food allergies, allergic rhinitis, and eosinophilic esophagitis.
What Are the Symptoms of FPIES?
An FPIES reaction will typically result in symptoms two to four hours after the trigger food is ingested. These symptoms include:
- Severe vomiting
- Low body temperature
- In rare cases, the child may go into shock
FPIES does not cause symptoms commonly associated with other allergies such as a rash, congestion, runny nose, coughing, trouble breathing and anaphylaxis.
What Causes FPIES?
FPIES reactions are triggered by eating a particular food, although how foods trigger symptoms is not fully understood. FPIES is thought to be caused by an immune reaction to the protein component of foods such as milk.
Most children will only have one trigger food for FPIES and only need to avoid one food. If your child reacts to more than one food, it’s best to discuss management with an allergy specialist and an experienced pediatric allergy dietician.
If your child is already consuming a high-risk food without any reactions, these foods should continue to be regularly included in their diet. Symptoms usually develop after the first or second time a trigger food is eaten.
How is FPIES Diagnosed?
FPIES is commonly misdiagnosed as food poisoning or a severe stomach bug because the symptoms are so similar. It is generally only after repeated ingestion of the trigger food (followed by severe symptoms hours later) that indicate FPIES may be the cause.
FPIES is a non-IgE food allergy, which means it cannot be diagnosed with readily available food allergy tests such as a skin prick test or blood tests. A careful history and physical examination is key for a FPIES diagnosis. During an acute episode, lab findings may find an elevated white blood cell count, elevated platelet count, anemia (low red blood cell count), or low albumin. The most definitive test is a medically supervised oral food challenge (OFC) where the suspect food is given to the child in a controlled clinical environment.
10 Common FPIES Trigger Foods
Any food can trigger FPIES but some of the most common trigger foods are:
- Cow’s milk
- Red meat
- Sweet potato and squash
- Green beans and peas
Will My Child Outgrow FPIES?
FPIES usually resolves with time. In 60 – 90% of affected children, FPIES is outgrown in the first three years of life, however, there are some children that have FPIES continued into adulthood. Your child will need to be closely followed by their doctor to discuss what foods are safe to eat and when FPIES may be resolved.
Can Adults Develop FPIES?
Although FPIES is most commonly diagnosed in infants and young children, in recent years, new-onset adult FPIES has been found. Adults with FPIES tend to have a different symptom profile and different food triggers (typically seafood) compared to children with FPIES and require age-appropriate resources.
5 Tips for Treating and Managing FPIES Reactions
- Avoid trigger foods. This is the main (and only) way to prevent FPIES symptoms from occurring. Pay special attention to your child’s diet to figure out what their trigger food(s) is, so it can be strictly avoided. This includes all forms of the allergen, including baked and processed foods.
- Work with a dietician to create a food allergy management plan for your child that includes safe dietary elimination. They’ll also review lower-risk foods to start with and how often to introduce a new food. It’s important your child obtains the optimal nutrition necessary for appropriate growth and development. The dietician can also offer additional insights, such as ideas for recipes, new ways of preparing foods and information on foods your family may not be familiar with. They can also offer ideas for introducing texture in the diet to help your child progress with age-appropriate feeding skills.
- Focus on feeding skill development. The first FPIES episode can be traumatic to the point where some parents are hesitant to give new foods to their child in case it happens again. However, it’s important to introduce a wide range of foods during the first year of life as limiting foods can lead to nutritional deficiencies, poor growth, food refusal and feeding difficulties. In fact, delayed introduction of common allergenic foods like eggs and peanut butter can increase the risk of developing an allergy to these foods. Work with your dietician or doctor to figure out the best path for introducing foods to your child’s diet.
- Oral food challenges should never be conducted at home, even if you think your child has outgrown their allergy. To determine whether your child has outgrown their allergy, an OFC can be conducted in a clinic or hospital setting under the guidance of a physician.
- If your child is having challenges with eating solids or an aversion to spoon or finger foods, reach out to your child’s doctor. They may recommend a consultation with a feeding specialist, typically a speech language pathologist or occupational therapist.
If your child has been diagnosed with FPIES, we hope you have gained some clarification about how to handle it. Always talk to your doctor about the best course of action for your particular case.
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