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What Does FPIES Stand For?

FPIES is Food Protein-Induced Enterocolitis Syndrome. Enterocolitis is inflammation involving both the small intestine and the colon (large intestine).

FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea.

FPIES is presumed to be cell mediated. Poor growth may occur with continual ingestion. Upon removing the problem food(s), all FPIES symptoms subside.

The most common FPIES triggers are cow’s milk (dairy) and soy [only because that’s what we mainly feed babies! – Prof.] In fact any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley.

“Stomach Flu” B*S*

A child with FPIES may experience what appears to be a severe stomach bug, but the “bug” only starts a couple hours after the offending food is given. Many FPIES parents have rushed their children to the ER, limp from extreme, repeated projectile vomiting, only to be told, “It’s the stomach flu.” However, the next time they feed their children the same solids, the dramatic symptoms return.

What Does IgE vs Cell Mediated Mean?

IgE stands for Immunoglobulin E. It is a type of antibody, formed to protect the body from infection, that functions in allergic reactions. Antibodies are not involved in cell mediated reactions. For the purpose of understanding FPIES, you can disregard all you know about IgE-mediated reactions.

FPIES reactions often show up in the first weeks or months of life, or at an older age for the exclusively breastfed child. Reactions usually occur upon introducing first solid foods, such as infant cereals or formulas, which are typically made with dairy or soy. It’s Nature’s way of saying milk and soy are Yuck for my infants!

While a child may have allergies and intolerances to food proteins they are exposed to through breastmilk, FPIES reactions usually don’t occur from breastmilk, regardless of the mother’s diet. An FPIES reaction typically takes place when the child has directly ingested the trigger food(s).

Symptoms

What is a Typical FPIES Reaction?

As with all things, each child is different, and the range, severity and duration of symptoms may vary from reaction to reaction. Unlike traditional IgE-mediated allergies, FPIES reactions do not manifest with itching, hives, swelling, coughing or wheezing, etc. Symptoms typically only involve the gastrointestinal system, and other body organs are not involved.

these other reactions occur, in other organs… we’ll just ignore them, eh? – Prof.

FPIES reactions almost always begin with delayed onset vomiting (usually two hours after ingestion, sometimes as late as eight hours after). Symptoms can range from mild (an increase in reflux and several days of runny stools) to life threatening (shock). In severe cases, after repeatedly vomiting, children often begin vomiting bile.

Commonly, diarrhea follows and can last up to several days. In the worst reactions (about 20% of the time), the child has such severe vomiting and diarrhea that s/he rapidly becomes seriously dehydrated and may go into shock.

How Do You Treat an FPIES Reaction?

Always follow your doctor’s emergency plan pertaining to your specific situation. Rapid dehydration and shock are medical emergencies. If your child is experiencing symptoms of FPIES or shock, immediately contact your local emergency services.

What are Some Common FPIES Triggers?

The most common FPIES triggers are traditional first foods, such as dairy and soy. Other common triggers are rice, oat, barley, green beans, peas, sweet potatoes, squash, chicken and turkey. A reaction to one common food does not mean that all of the common foods will be an issue, but patients are often advised to proceed with caution with those foods.

Note that while the above foods are the most prevalent, they are not exclusive triggers. Any food has the potential to trigger an FPIES reaction. Even trace amounts can cause a reaction.

Is FPIES A Lifelong Condition?

The orthodox answer to this is a joke! Typically, no, they say. Many children outgrow FPIES by about age three. In one study, 100% of children with FPIES reactions to barley had outgrown and were tolerating barley by age three.

But they were not measuring and were completely unaware of the phenomenon in which allergies change and shift.

[FURTHER READING]

Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. (2006). Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome. Pediatric Allergy and Immunology 17: 351–355. Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_3/S116.

Burks, AW. (2006). Don’t Feed Her That! Diagnosing and Managing Pediatric Food Allergy. Pediatric Basics. Gerber Products Company: 115. Retrieved on December 31, 2007 from http://www.gerber.com/content/usa/html/pages/pediatricbasics/articles/115_01-dontfeed.html.

Moore, D. Food Protein-Induced Enterocolitis Syndrome. (2007, April 11). Retrieved on December 31, 2007 from http://allergies.about.com/od/foodallergies/a/fpies.htm.

Sicherer, SH. (2005). Food Protein-Induced Enterocolitis Syndrome: Case Presentations and Management Lessons. Journal of Allergy and Clinical Immunology Vol. 115, 1:149-156. Retrieved on December 31, 2007 from http://www.jacionline.org/article/PIIS0091674904024881/fulltext.

Nowak-Wegrzyn, A., Sampson, HA, Wood, RA, Sicherer, SH. MD, Robert A. Wood, MD and Scott H. Sicherer, MD. (2003). Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins. Pediatrics. Vol. 111. 4: 829-835. Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/full/111/4/829#T1.

Nocerino, A., Guandalini, S. (2006, April 11). Protein Intolerance. Retrieved on December 31, 2007 from http://www.emedicine.com/ped/topic1908.htm.

WebMD Medical Reference from Healthwise. (2006, May 31). Shock, Topic Overview. Retrieved on December 31, 2007 from http://www.webmd.com/a-to-z-guides/shock-topic-overview.

American Academy of Allergy, Asthma and Immunology. (2007). Tips to Remember: What is an Allergic Reaction? Retrieved on December 31, 2007 from http://www.aaaai.org/patients/publicedmat/tips/whatisallergicreaction.stm.

Sicherer, SH. (2006). Understanding and Managing Your Child’s Food Allergies. A Johns Hopkins Press Health Book. 336.