Food Protein Induced Enterocolitis Syndrome (FPIES)

Food Protein Induced Enterocolitis Syndrome (FPIES)Food Protein Induced Enterocolitis Syndrome, commonly known as FPIES, is a relatively rare, but potentially severe condition in newborns and infants. This condition often presents in the first few weeks or months of life, or at an older age in the exclusively breastfed baby. In exclusively nursing infants, symptoms may first present upon the introduction of commercial formula or solid foods such as cereals, which typically contain cow’s milk, soy, or another offending protein. Symptoms occur only when the newborn or infant has ingested the offending protein, and does not occur from breast milk, regardless of the maternal diet.

Symptoms typically present shortly after the ingestion of the food protein to which the child is sensitive, commonly within two hours of ingestion, but they may be delayed as long as 8 hours. Symptoms are exclusively gastrointestinal, with the most common symptoms being vomiting and diarrhea. Unlike an allergic reaction, this non-allergic reaction is not accompanied by cutaneous symptoms such as itching, hives, or swelling; nor are there respiratory symptoms such as congestion, coughing, wheezing, or difficulty breathing. Symptoms of FPIES can vary between mild and severe. When mild, minor diarrhea or mild to moderate colic symptoms may predominate. When severe, profuse vomiting and diarrhea occurs, and emergency treatment should include the replacement of fluids due to the possible rapid onset of dehydration, and even shock. Corticosteroids are sometimes administered, but the injection of epinephrine is of no benefit during this reaction.

Contrary to popular belief, FPIES is not an allergy; rather it is a gastrointestinal intolerance to a food protein. Therefore, this condition cannot be diagnosed by allergy testing, either by skin testing or by blood testing. The clinical diagnosis is generally made by a clinical history consistent with typical symptoms after eating a given food. The diagnosis is generally confirmed if and when symptoms occur each time the food is introduced to the child.

The most common foods to the cause this condition are milk and soy. However, other solid foods may also precipitate symptoms, including cereal grains (rice, oats, barley), legumes (peas, beans, lentils), and poultry such as chicken and turkey. It should be remembered that any food can cause FPIES, even in trace amounts.

Upon removing the offending food, all FPIES symptoms subside. Treatment of this condition consists solely of avoidance of the offending food. It is generally recommended that if a child has FPIES caused by cow’s milk protein formula, that soy formulas also he avoided due to the fact that soy is also a common cause of this syndrome.

Typically this condition resolves by 3 years of age. It is recommended that parents not attempt to determine if the child can tolerate the offending food at home; rather, it is recommended that an allergist or pediatrician attempt to introduce the food under close medical supervision.

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