Food Protein-Induced Enterocolitis Syndrome (FPIES)

This article has been reviewed by Thanai Pongdee, MD, FAAAAI

Food Protein-Induced Enterocolitis Syndrome (FPIES), sometimes referred to as a delayed food allergy, is a severe condition causing vomiting and diarrhea. In some cases, symptoms can progress to dehydration and shock brought on by low blood pressure and poor blood circulation.

Much like other food allergies, FPIES allergic reactions are triggered by ingesting a food allergen. Although any food can be a trigger, the most common culprits include milk, soy and grains. Most children with FPIES have only one or two food triggers, but it is possible to have FPIES reactions to multiple foods. FPIES often develops in infancy, usually when a baby is introduced to solid food or formula.

There are differences that set FPIES apart from a typical food allergy. Most food allergy reactions happen within minutes or shortly after coming in contact with a food allergen. FPIES allergic reactions are delayed, occurring within hours after eating the trigger allergen. In most allergies, the immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. FPIES reactions are thought to involve cells of the immune system rather than IgE antibodies.

Diagnosing FPIES
Symptoms of FPIES overlap with other medical conditions, so a diagnosis is not always obvious. Because there are no laboratory or skin tests to confirm delayed food allergy, diagnosing FPIES is based on history, symptoms and physical examination. An allergist / immunologist will take a detailed history, including foods eaten and a timeline of reactions.

Treatment & Management
The best way to manage FPRIES is to strictly avoid the food that triggers an allergic response.
This requires careful attention to your child’s diet. If a severe reaction does occur, treatment includes the administration of intravenous fluids to counteract fluid loss from vomiting and diarrhea. Steroids may also be given to calm the reaction.

The good news is FPIES usually resolves with time. Your child will need to be closely followed by a physician to discuss what foods are safe and when it may be time to determine if FPIES has resolved. With proper medical attention and a personalized dietary plan to ensure proper nutrition, children with FPIES can grow and thrive.

For more informtion on FPIES please contact The International Association for Food Protein Enterocolitis (IAFFPE).

AAAAI - American Academy of Allergy Asthma & Immunology