FPIES
Introduction
Food protein–induced enterocolitis syndrome (FPIES) is an immunologic reaction that occurs in the digestion system. It is often unrecognized and undiagnosed. The reaction is often delayed and may occur 1-6 hours after food ingestion. The major symptom is profuse vomiting, usually at least 1 hour after food ingestion. The most common implicated foods for children are milk, soy, rice, and oats. Shellfish is the most common trigger in adults.
What are the symptoms of FPIES?
- Vomiting (often repetitive) 1-4 hours after ingestion
- Lethargy
- Pallor
Natural history
Food protein-induced enterocolitis
FPIES often presents prior to 6 months of age in formula–fed and infants with repetitive vomiting, lethargy, and dehydration 1-5 hours after food ingestion. The most common foods include milk, soy, rice, and oats. Other foods that have been reported include barley, chicken, turkey, egg, pea, peanut, sweet potato, white potato, free protein, fish, and shellfish. In 60-90% of children, FPIES resolves by 3 years of age. FPIES can occur in adults, especially to shellfish. The reactions can occasionally be severe with significant dehydration requiring emergency room visits and sometimes even hospitalization. FPIES can sometimes be confused with a severe infection called sepsis.
Treatment and Prevention
of Food Allergies
Management of FPIES
FPIES can be treated with anti-emetics and intravenous hydration. There is no treatment that cures FPIES at this time. The mainstay of treatment is strict avoidance of the offending food. The patient/family will need education and support regarding what foods to add to the diet since FPIES may occur to more than 1 food. Oral challenges are the only diagnostic test available to confirm FPIES and whether it has been outgrown over time.
Further support/information
FPIES is a complex disorder that may seem overwhelming. Individuals and families may benefit from participating in support groups, as well as lay organizations such as the International FPIES Association and The FPIES Foundation. The International Consensus Guidelines for the Diagnosis and Management of FPIES was published (2017) in the Journal of Allergy and Clinical Immunology. Click here for an FPIES fact sheet and here for an FPIES ER letter. Additional resources include an FPIES weaning guide, FPIES co-allergies, and FPIES emergency room orders.
