FPIES – Is it something you should be concerned about?

Have you heard of FPIES?

What is FPIES? Recently this topic came up at a First Aid update. This is because the childcare centre had not one, but two, cases of FPIES in their service. All in the past few months and most of the staff had never heard of it before.

To be honest, I too hadn’t heard of it and this prompted me to learn more about it. I also thought it would be best to get the word out there so that others can be aware of the risks that come with not knowing about it, should they come across it.
Check out what I learn about it below. I have also attached some links to where you can get more information. Make sure to download the Allergies Australia Action Plan for it. 

What is FPIES? 

It is a Food protein-induced enterocolitis syndrome and is an adverse food reaction involving the immune system that mainly affects infants and young children.
It is caused by an allergic reaction to one or more ingested foods which results in inflammation of the small and large intestine.

What are its symptoms?

Symptoms include profuse vomiting (and sometimes diarrhea) most commonly occur two to four hours after eating a food that has been recently introduced into the diet. Some children may become pale, floppy, have reduced body temperature, and/or blood pressure during a reaction.

Avoidance of the trigger food protein/s is currently the only effective treatment option. However, most children will outgrow it in the preschool years.

Which foods can triggers it?

The most common triggers are rice, cow’s milk (dairy) and soy. However, almost any food can cause its reaction, including cereals such as rice, oats, eggs, legumes and meats such as chicken and seafood. It rarely occurs in exclusively breastfed infants.

How it is different to many common food allergies? 

It is possible for a child who have it to also have Immunoglobulin E (IgE) mediated allergies to other foods. They can have other allergic diseases such as eczema and asthma. 

  • Is usually a delayed reaction.

  • Allergy reactions only involve the gastrointestinal system.

  • No hives, welts or swellings are seen on the face or body.

  • Is not associated with anaphylaxis.

  • Adrenaline (epinephrine) autoinjectors are NOT used to treat the reaction.

Is it possible to have it to more than one food?

Some children have it to more than one food protein. For example, some children with FPIES to cow’s milk have been noted to react to soy, and some with rice have also reacted to oats. Children to chicken may react to other poultry such as turkey.

How is it diagnosed?

There are no laboratory or skin tests which can confirm a diagnosis of it. This makes diagnosis difficult.

  • During an FPIES reaction some children may have an elevated white cell and platelet count, and may be mistaken for having an infection.

  • Skin tests or blood tests for allergen specific IgE to the food protein/s are not helpful.

  • Medically supervised oral food challenges can be useful when the history is not clear, or when other foods from similar food groups are being introduced into the diet for the first time.

  • Medically supervised oral food challenges can be useful to establish when a child has outgrown it.

How is it treated?

Currently the only specific management option for it is avoidance of the trigger food/s.

Infants who have reacted to cow’s milk and soy formulas will usually be trialed on extensively hydrolysed formula (eHF), or amino acid based formula (AAF), if eHF is not tolerated.

Most families of children who have it will be given a letter to present to emergency departments explaining their child’s condition and the appropriate treatment.

Treatment during of its reaction may include:

  • Intravenous (IV) fluids, because of the risk of dehydration.

  • Corticosteroids and in-hospital monitoring, for more severe symptoms.

There is no role for the use of adrenaline (epinephrine) autoinjectors in the management of it .

Does FPIES resolve?

Most children outgrow FPIES by about three to four years of age. However, this varies between individuals and foods. Only 40-80% of children with FPIES to rice, and 60% to dairy, tolerated these foods by the ages of three to four. The best way to determine whether a child has outgrown their FPIES is by a medically supervised food challenge.

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