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 particular food. 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 food. 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.
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 FPIES is to strictly avoid the food that triggers an allergic reaction. 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.
International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology
Novel immune activation pathways identified in Food Protein Induced Enterocolitis Syndrome (FPIES)
New insights in the understanding of FPIES pathomechanisms
2017 Non-CME Recordings
For more informtion on FPIES please contact The International FPIES Association (I-FPIES).
This article has been reviewed by Andrew Moore, MD, FAAAAI