Food Protein-Induced Enterocolitis Syndrome (FPIES)

What is food protein-induced enterocolitis syndrome (FPIES)?

Food protein-induced enterocolitis syndrome (FPIES) is a rare allergic reaction disorder that affects the gastrointestinal system, specifically causing inflammation of the small and large intestines. The symptoms of this condition occur a few hours after ingesting the trigger food. In addition, unlike other food allergies, a FPIES attack is contained to the GI tract.

What causes food protein-induced enterocolitis syndrome (FPIES)?

FPIES is caused by cells in the immune system reacting badly to certain foods, though the exact cause of this is unknown. It is also worth noting that a significant portion of children affected by FPIES have family members with other types of allergies, such as hay fever or eczema. The most common foods that trigger an attack are cow milk and dairy products, soy or soymilk, and wheat and other grains.

What are the symptoms of food protein-induced enterocolitis syndrome (FPIES)?

The symptoms of FPIES are easily confused with gas, acid reflux, or a stomach bug. However, characteristically, a couple of hours after eating, a child will vomit over and over and then get diarrhea. Sometimes, these symptoms get worse over time, causing some patients to fail to thrive. Pallor, lethargy, and abdominal swelling can also occur. Severe attacks of FPIES can lead to dehydration and shock, which can in turn cause a sudden drop in blood pressure or body temperature. Symptoms of a severe attack include:

Apparent confusion
Cool, clammy, or blue skin
Extreme thirst
Shallow breaths
Weak pulse

How is food protein-induced enterocolitis syndrome (FPIES) diagnosed?

An allergist or pediatric gastroenterologist can assist in a diagnosis of FPIES, first by ruling out other common causes of vomiting and diarrhea. In some cases, blood tests and atopy patch tests (APT) can help confirm a diagnosis, but the only way to tell for sure is to do an oral food challenge, or OFC, in a clinic or hospital.

What are the available treatments for food protein-induced enterocolitis syndrome (FPIES)?

Treatment for FPIES revolves around removing the trigger food from the child’s diet, but some infants may need to be treated by being fed exclusively breastmilk. Severe attacks of FPIES will require medical intervention by means of intravenous fluids and/or anti-inflammatory drugs. Fortunately, many children will then outgrow their reactions usually by three or four years of age.