Food Protein-Induced Enterocolitis Syndrome (FPIES)

What is FPIES?

Food Protein-Induced Enterocolitis Syndrome (FPIES), pronounced F-pies, is a type of non-IgE-mediated food allergy.

FPIES is a delayed gut allergic reaction that usually occurs in the first two years of life, most often during early infancy (4-6 months of age) when a baby starts eating solids. FPIES reactions can occur in the first few months of life in non-breastfed babies. FPIES rarely occurs in fully breastfed babies.

FPIES is thought to affect 1-3 per 1000 infants under 2 years of age.

Signs of FPIES

• Severe vomiting (like a fire hydrant) that usually starts within 1-4 hours after eating the trigger food or drink
• Diarrhoea
• Pale, floppy (children)
• Cold to touch
• Skin signs and anaphylaxis DO NOT occur in FPIES.

What foods cause FPIES?

The most common food triggers are rice, cow’s milk (dairy), soy, egg, oats, legumes, sweet potato and chicken. However, any food can cause FPIES. Most babies (75%) have FPIES to only one food.

FPIES can occur in adults, but this is uncommon. The most common food trigger for adults is seafood and egg. Symptoms are not as severe as babies and often occurs as stomach pain.

Foods with Precautionary Allergen Labelling (PAL) statements (such as ‘may contain xx’) do not need to be avoided as they contain very small amounts of the trigger food and therefore will not cause an FPIES reaction in most people.

Diagnosis of FPIES

If FPIES is suspected, a referral should be made to an allergy specialist.

An ASCIA Action Plan for FPIES should be completed by your doctor. FPIES cannot be diagnosed with a skin prick test or IgE antibody blood test, so doctors use the patient’s clinical history to make the diagnosis.

Management and treatment of FPIES

FPIES is managed by the avoidance of the food allergen that causes the FPIES reaction.

FPIES reactions are managed by following your ASCIA Action Plan for FPIES.

Sometimes medication is prescribed that you can give at home to help reduce the vomiting. If the vomiting is severe and/or your baby becomes pale and floppy, it is recommended you call triple zero (000) for an ambulance for additional medical care to be provided. This is usually intravenous (IV) fluids (fluids through a drip put in the baby’s arm or foot) to replace the baby’s fluid that was lost due to vomiting and diarrhoea.

Adrenaline devices and antihistamines used for other food allergic reactions will not treat an FPIES reaction.

Long-term outcomes with FPIES

Most children will outgrow FPIES before they start school. An in-hospital oral food challenge is usually done at age 3 – 4 years to see if FPIES has been outgrown.

Useful links

A&AA has a helpful webinar: Understanding FPIES.

ASCIA has information on Frequently Asked Questions on FPIES.