Food Protein Induced Enterocolitis

What is it?

FPIES is a delayed adverse reaction to food that typically affects infants and young children.  It can be quite severe and even life-threatening.  The most common symptoms of FPIES include repetitive vomiting, profuse diarrhea, and, occasionally, dehydration. These symptoms can lead to lethargy (acting listless or not responsive), lowering of core body temperature and low blood pressure. Symptoms of FPIES are not like the typical food allergy. The symptoms may not be immediate and the trigger foods are not revealed on standard allergy skin or blood tests.

What causes it?

In infancy, FPIES reactions are usually caused by cow’s milk protein formula or occasionally by soy.  Proteins in breast milk may also cause symptoms in some infants.  For older infants/toddlers experiencing FPIES with solid foods, rice and oats are the most common triggers. Other common FPIES triggers include barley, green beans, peas, poultry, soy, squash, and sweet potatoes. However, any food protein can be a trigger!

How is it diagnosed?

FPIES is usually diagnosed through a careful history of the characteristic symptoms and exclusion of other similar disease states.  Our allergist/immunologist and a gastroenterologist should be involved in making the diagnosis and treatment plan. Although Atopy Patch Testing (APT) is often used for FPIES patients, it is not a validated test for a FPIES diagnosis. The most definitive test is a medically supervised oral food challenge (OFC)-where the suspected food is given to the child in a controlled clinical environment.


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