Types of Food Allergies

Food Protein-Induced Enterocolitis Syndrome (FPIES)

Food protein-induced enterocolitis syndrome (FPIES) is a type of gastrointestinal food allergy that affects mostly infants and young children.

Overview

Children with FPIES experience chronic vomiting and diarrhea, usually after consuming dairy or soy products, and are often diagnosed with “failure to thrive” (inadequate weight gain or growth).

FPIES is a serious condition that can require hospitalization in the most extreme cases. Encouragingly, most children outgrow it by age 3 or 4.

Researchers have found that 40 to 80 percent of FPIES patients have a family history of allergic diseases (asthma, hay fever or eczema); 20 percent have a family history of food allergy.

FPIES Symptoms

  • Chronic vomiting
  • Diarrhea (sometimes bloody)
  • Weight loss
  • Dehydration
  • Lethargy
  • Failure to thrive

For more information on FPIES allergy symptoms click here.

FPIES Triggers

  • Soy and dairy products, particularly infant formula
  • Some cereal grains, such as rice and oats
  • Chicken, turkey and fish

FPIES Management and Treatment

  • Avoid the trigger food.
  • Follow the allergist’s instructions on what to eat.
  • For more information on FPIES allergy management and treatment click here.

FPIES Symptoms

FPIES symptoms begin early in life, typically occurring after the introduction of milk- or soy-based formulas. Symptoms can also develop after an infant starts eating rice, oats, barley and similar foods, typically after 4 months of age.

Unlike some food-allergic reactions that can trigger an allergic response throughout the body, the symptoms of FPIES typically are confined to the gastrointestinal system. Vomiting and diarrhea may not occur until several hours after the offending food is consumed, so a link between the symptom and the food may not be apparent. 

Symptoms include:

  • Chronic vomiting
  • Diarrhea (sometimes bloody)
  • Weight loss
  • Dehydration
  • Lethargy
  • Failure to thrive

In the most extreme cases, children with FPIES can require hospitalization. If you suspect that your child has symptoms of FPIES, see an allergist for diagnosis and treatment.

Diagnosing FPIES

Diagnosis of FPIES can be a challenge, as this disorder often is mistaken for a bacterial infection (sepsis) or viral illness. Although it is an allergy, it cannot be easily identified through the usual skin-prick or blood tests for food allergies. (Research shows that children with FPIES who do have a positive result to those tests may take longer to outgrow the condition and are at risk for developing additional food allergies.)

If you suspect that your child has FPIES, consult an allergist, who will take into account your child’s clinical history and symptoms and exclude other causes.

In some cases, a clinically supervised oral food challenge is necessary to confirm FPIES. This usually is not necessary with infants whose symptoms go away once they are no longer consuming the offending food. An oral food challenge also may be helpful in determining whether a child has outgrown FPIES.  

FPIES Management and Treatment

Strict avoidance of the trigger food is key.

If your child has FPIES, your allergist may advise you switch to using a hypoallergenic formula, such as a casein hydrolysate-based formula. If your child has solid-food FPIES, your allergist may suggest introducing yellow fruits and vegetables (pears, bananas, corn and potatoes, for example), rather than cereal.

Cases of FPIES among exclusively breast-fed babies are very rare. Infants who are breast-fed and then are moved to a milk- or soy-based formula can develop FPIES.

In extreme cases, hospitalization may be necessary so the child can be rehydrated with IV fluids.

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