What is the Food Protein Induced Enterocolitis Syndrome?
Food protein induced enterocolitis syndrome, or FPIES, is a disease of infants and young children that mimics food allergies. Symptoms typically include vomiting, diarrhea (sometimes bloody), dehydration and low-blood pressure. The child or infant can appear lethargic, and over time can have problems gaining weight. Hospitalization for possible severe infection in common in children with FPIES.Symptoms of FPIES typically occur shortly after consuming the culprit food. Vomiting starts within 2 hours after eating the causative food, and diarrhea typically starts within 5 hours of eating.
While FPIES can mimic food allergies, symptoms typically only consist of gastrointestinal symptoms, and other body organs are not involved. There is no skin involvement in FPIES (hives/swelling, itching), and no respiratory symptoms (runny nose, sneezing, coughing, or wheezing), which are commonly seen in true food allergy. And, typical allergy tests to the causative foods are negative in FPIES.
What Foods Cause FPIES?
The most common foods implicated in the cause of FPIES are milk and soy formulas. However, solid foods can also cause the problem, most commonly cereal grains (oats, rice, barely), legumes (peas, lentils, beans) and poultry (such as chicken and turkey).
Foods that are typically tolerated by children with FPIES include breast milk and hydrolyzed casein infant formulas (such as Alimentum).
How is FPIES Diagnosed?
FPIES is typically a clinical diagnosis made by having a history of symptoms consistent with this syndrome after eating suspect foods. An allergist may perform allergy testing to ensure that true allergy is not present. There is typically no need to perform an oral food challenge in young children to prove that foods are causing the symptoms, and this can be extremely dangerous.How is FPIES Treated?
Avoidance of the suspect foods, as well as other foods that commonly cause the disorder, is the mainstay of therapy in children with FPIES. If the child has FPIES caused by a cow’s milk based infant formula, soy formula should also be avoided, given that soy can also commonly cause this syndrome. Avoidance of cereal grains, poultry and legumes is also recommended. Most fruits and vegetables are not causative foods and are typically tolerated in children with FPIES. Learn more about avoidance of specific foods.Once symptoms do occur, treatment should be sought in an emergency room given that children may develop low blood pressure along with vomiting and diarrhea. It is recommended that the diagnosing physician (usually an allergist) write a letter explaining that the child suffers from FPIES, and the recommended treatment course if there is an accidental ingestion of the food. The child should be monitored for a minimum of 4 hours after eating the culprit food, as it may take this long for symptoms to occur.
Once symptoms do occur, intravenous fluids and steroids are typically required. Injectable epinephrine is not typically needed but may also be given, along with other injectable medications if the child’s blood pressure remains low.
At What Age Does FPIES Resolve?
Typically, FPIES resolves by age 3, meaning that the child is likely to be able to tolerate the culprit foods after this age. However, parents should not attempt to determine if the child can tolerate the food at home. Rather, an allergist may choose to feed the child the culprit food under close medical supervision, such as in the doctor’s office or in the hospital. It is recommended to perform these oral food challenges with an intravenous catheter in place.Are There Other Non-Allergic Diseases Caused by Foods that Mimic FPIES?
Another food-intolerance, called dietary protein proctitis, is characterized by blood-streaked stools in very young infants, usually starting at 1-2 months of age. These children do not have vomiting, and otherwise appear well. This food intolerance is often related to cow’s milk or soy formulas, or due to the presence of milk, soy or egg protein in breast milk. These children typically can tolerate the causative foods at about 1 year of age.Dietary protein enteropathy most closely resembles FPIES, with children experiencing vomiting, diarrhea and difficulty gaining weight. These children lack severe symptoms of lethargy and low blood pressure. Symptoms begin in infancy to 2 years of age, and typically resolve by 3 years of age. Culprit foods include cow’s milk, soy, cereal grains, egg and fish.
Want to keep learning? Find out about ways to prevent the development of food allergies in infants and young children.
Sources:
- 1. Sicherer SH. Food Protein-Induced Enterocolitis Syndrome: Case Presentations and Management Lessons. J Allergy Clin Immunol. 2005;115:149-56.
- 2. Sampson HA, Anderson JA. Classification of Gastrointestinal Manifestations Due to Immunologic Reactions to Foods in Infants and Young Children. J Pediatr Gastro Nutr. 2000;30:S87-94.
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