22 August 2023

Food Protein Induced Enterocolitis Syndrome (FPIES) is a food allergy that affects young children. It can occur any time around or after four months, which is about the time an infant will start on solids like rice and oats. Generally it will disappear when the child reaches about age three or four.

Just because it will eventually go away, it is not something to be ignored. It causes vomiting and diarrhea which can lead to dehydration and shock. In some children, the symptoms will get worse as time goes on and the child does not grow as they should. This poor growth is confused with failure to thrive.

Basically the child’s immune system is reacting to a food or foods and this is causing gastrointestinal reactions that present as vomiting and/or diarrhea.

Severe cases include unexplained lethargy, low blood pressure, and change in body temperature. It is easily misdiagnosed as a gastrointestinal virus. The worst cases involve hospitalization with hydration and treatment to stop the vomiting. There is no specific test that can lead to the diagnosis of FPIES.

The reaction is triggered by ingesting a particular food or liquid. Commonly these include cow’s milk, soy products, and grains. Don’t rule out poultry and fish. It is sometimes thought that the reactions occurs in food families rather than isolated sources. However, there is nowhere near enough data or research to give a definitive cause. The symptoms are usually delayed by an hour or two but can take as much as six hours to begin. This condition often occurs in families where other members have allergies, including those unrelated like hay fever or eczema. In fact, in only about 20% of the cases do other family members have food allergies.

The only way to determine the source of the allergy is to delete foods from the diet and then reintroduce them to see I there is a reaction. The safest way to handle this is in a clinic or hospital so that the child can be monitored and any severe reactions handled immediately to prevent life threatening conditions to persist.

Diagnosis relies on recognizing the symptoms during an acute phase, supported by some laboratory tests and their results. This disease is not understood very well even by the experts. At this point, it is speculated that T-cells are disturbed by food allergens and will then start an intestinal inflammation.

Consulting with an allergist or a pediatric gastroenterologist is the best tactic. After ruling out common causes, allergy reaction tests will be run and sometimes a patch test can help determine the problems. However, these are not definitive tests to indicate FPIES.

You can expect to switch to a hypoallergenic formula or, if the child is eating solids, substituting fruits for grains. Those children who are exclusively breast-fed are unlikely to develop this allergy unless they are moved to a formula feeding.

An allergy is different from an intolerance. An intolerance does not involve the immune system and the treatment also differs. If you have any concerns with your child’s ability to tolerate milk or foods, start with your pediatrician. If possible keep a diary or take notes about what your child is consuming and how soon the symptoms start. Include anything that seems out of the norm, even if it does not involve vomiting or diarrhea. This should be a good jumping off point for your medical team.

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