FPIES Food protein-induced enterocolitis syndrome

FPIES Food protein-induced enterocolitis syndrome

FPIES is very difficult to diagnose

What is Food protein-induced enterocolitis syndrome (FPIES)

Food Protein Induced Enterocolitis Syndrome (FPIES), sometimes referred to as a delayed food allergy, mainly occur in infant and children where the allergic symptoms start after hours of taking food. Most of the child having recurrent vomiting and diarrhea. Children are usually presented with failure to thrive. In extreme cases child may have dehydration and shock.

There are some differences which distinguishes FPIES from a typical food allergy. In typical food allergy the reaction start within minutes after taking the offending food but in FPIES allergic reactions are delayed, occurring within hours after eating the trigger food. In typical allergy our immune system overreacts to the allergen and produces Immunoglobulin E (IgE) antibodies. But FPIES reactions may  involve cells of the immune system rather than IgE antibodies.

Although any food can be a triggering factor for FPIES, the most common offenders include milk, soy and grains.

Symptoms of FPIES

  • Chronic vomiting
  • Diarrhea , sometimes bloody
  • Weight loss
  • Dehydration
  • Lethargy
  • Failure to thrive (FTT)
  • Shock

Causes of FPIES

Although any food can be a triggering factor for FPIES, the most common offenders include milk, soy and grains.

FPIES Triggers

  • Soy and dairy products, particularly infant formula
  • Some cereal grains, such as rice and oats
  • Chicken, turkey and fish

Diagnosis of FPIES

FPIES is difficult to diagnose. Most of the cases symptoms of FPIES overlap with other medical conditions. Patient may present with FTT, shock, sepsis or viral infection. As there are no confirmatory laboratory or skin tests to diagnose delayed food allergy, diagnosing FPIES is based on detailed history taking, and physical examination.

Treatment of FPIES

  • Strict avoidance of causative food allergen
  • Management of FTT
  • Treatment of dehydration
  • Management of sepsis
  • Therapy to manage shock
  • Appropriate management of  concurrent medical condition

One can use hypoallergenic formula, such as a casein hydrolysate-based formula. Based on your child symptoms your physician may suggest introduction of yellow fruits and vegetables (like pears, bananas, corn and potatoes etc.) rather than cereal.

Food Allergy Mimickers

Common conditions that mimic food allergy include:

  • Lactase deficiency / lactose intolerance
  • Food poisoning
  • Celiac disease. sometimes called to as a gluten allergy
  • Sensitivity to food additives.eg sulfites used in dried fruit, canned goods
  • Histamine toxicity from certain not refrigerated fish

Read in-depth of FPIES

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Point to be remembered in managing Food Allergy

Avoidance of the offending food is the best way to prevent food allergy. One must know the causative food to which he is allergic. A person with food allergy must be cautious when eating in  restaurants and in social events.

If you have  food allergy, then follow these steps:

  • Know what you’re eating and drinking. Always see the food labels while you eating something.
  • If you have already had a severe reaction/anaphylaxis, wear a medical alert bracelet or necklace that will alert others and you have a food allergy.
  • Have an action plan ready. Always have a action plan of your food allergy.
  • Have an Epinephrine / Adrenaline Autoinjector with you.
  • Be careful while eating at restaurants.
  • Plan your meals and snacks before leaving home.

If your child has food allergy, you must follow few steps to ensure your child is safe:

  • Always notify key people about the child’s food allergy. Inform your child care providers, school personnel, parents of your child’s friends and other adults who regularly interact with your child. Tell them that food allergy may be life threatening and may require urgent intervention to save life of the child.
  • Explain food allergy symptoms to persons who spend time with the child.
  • Have a written action plan.This plan should include the appropriate management strategies to care the child in case of food allergy and in emergency case of anaphylaxis. Give one copy to school authority.
  • Have your child wear a medical alert bracelet or necklace to display that he/she has Food Allergy.

In-depth reading about of Food protein-induced enterocolitis syndrome (FPIES)

What is Food protein induced enterocolitis syndrome (FPIES)?

Food Protein Induced Enterocolitis Syndrome (FPIES), sometimes referred to as a delayed food allergy, mainly occur in infant and children where the allergic symptoms start after hours of taking food. Most of the child having recurrent vomiting and diarrhea. Children are usually presented with failure to thrive. In extreme cases child may have dehydration and shock.

There are some differences which distinguishes FPIES from a typical food allergy. In typical food allergy the reaction start within minutes after taking the offending food but in FPIES allergic reactions are delayed, occurring within hours after eating the trigger food. In typical allergy our immune system overreacts to the allergen and produces Immunoglobulin E (IgE) antibodies. But FPIES reactions are thought to involve cells of the immune system rather than IgE antibodies.

Although any food can be a triggering factor for FPIES, the most common offenders include milk, soy and grains.

Symptoms of FPIES

  • Chronic vomiting
  • Diarrhea , sometimes bloody
  • Weight loss
  • Dehydration
  • Lethargy
  • Failure to thrive (FTT)
  • Shock

Causes of FPIES

Although any food can be a triggering factor for FPIES, the most common offenders include milk, soy and grains.

FPIES Triggers

  • Soy and dairy products, particularly infant formula
  • Some cereal grains, such as rice and oats
  • Chicken, turkey and fish

Diagnosis of FPIES

FPIES is difficult to diagnose. Most of the cases symptoms of FPIES overlap with other medical conditions. Patient may present with FTT, shock, sepsis or viral infection. As there are no confirmatory laboratory or skin tests to diagnose delayed food allergy, diagnosing FPIES is based on detailed history taking, and physical examination.

FPIES is a non-IgE food allergy. Skin prick test (SPT) or blood test that measure food IgE antibodies (RAST) which s classically positive in other food allergy, is usually negative in FPIES. To make a diagnosis often a team of doctor including physician, allergist and gastroenterologist is necessary. Although Atopy Patch testing (APT) is used for FPIES patients, but it is not a validated test for FPIES diagnosis.

Treatment of Food Protein Induced Enterocolitis Syndrome

  • Strict avoidance of causative food allergen
  • Appropriate management of FTT
  • Management of dehydration
  • Treatment of sepsis
  • Therapy to manage shock
  • Management of concurrent medical condition

One can use hypoallergenic formula, such as a casein hydrolysate-based formula. Based on your child symptoms your physician may suggest introduction of yellow fruits and vegetables (like pears, bananas, corn and potatoes etc.) rather than cereal.

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