Food Protein Induced Enterocolitis Syndrome (FPIES)

FPIES (pronounced F-pies) is an uncommon food allergy caused by the immune system. FPIES commonly presents at around 4 – 6 months of age when a baby starts eating solid foods, but may appear earlier in formula fed babies.

What does an FPIES reaction look like?

Symptoms of FPIES include severe vomiting (like a fire-hydrant) that occurs 1 – 4 hours after drinking or eating the food that causes FPIES. The infant can also become less active and not interested in what is happening around them, pale and some babies become floppy and feel cold. Sometimes diarrhoea occurs 5 – 10 hours later.

How is FPIES treated during a reaction?

FPIES is treated in an emergency department where the infant is monitored. Sometimes intravenous fluids (fluids through a drip put in the babies arm or foot) are required to replace fluid lost due to vomiting. There is an ASCIA FPIES Action Plan to help parents and carers manage an emergency ASCIA Action Plan FPIES.

How is FPIES is different to other food allergies?

  • FPIES is a delayed reaction caused by the immune system

  • FPIES is a ‘non-IgE mediated allergy’ and is not caused by IgE antibodies

  • FPIES reactions involve the gastrointestinal system and there are no hives, welts, swelling or difficulty breathing

  • FPIES is not associated with anaphylaxis

  • Adrenaline (epinephrine) injectors (such as Anapen®, EpiPen®) are NOT used to treat FPIES

How common is FPIES?

The prevalence of FPIES varies around the world and ranges from 1 – 3 per 1000 infants under 2 years of age.

How is it diagnosed?

There are no blood or skin tests to diagnoses FPIES, so doctors use the clinical history to make the diagnosis. Sometimes medically supervised oral food challenges are used when the history is not clear. Infants with FPIES may also have other food allergies and / or eczema.

Common triggers

FPIES can be triggered by a large range of food proteins but the most common ones are cow’s milk, soy, rice, sweet potato, egg and chicken. FPIES rarely occurs in exclusively breastfed infants. When it does occur in breastfed infants, mothers can continue to consume the food that causes FPIES in their infant.

Is it possible to have FPIES to more than one food?

While most infants only have FPIES to one food, it is possible to have FPIES to many foods.  It is also possible to have FPIES and other types of food allergy (e.g. an IgE mediated egg allergy).

Treatment

The only treatment for FPIES is avoidance of the food allergen that causes the FPIES reaction. Most children will outgrow FPIES before they start school. A hospital oral food challenge is usually undertaken at age 3 – 4 years to see if FPIES has been outgrown. 

Useful links

ASCIA - Food Protein Induced Enterocolitis Syndrome (FPIES) including dietary guide

ASCIA Action Plan FPIES

Content updated June 2022

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IN AN EMERGENCY

If you are having an allergic reaction follow advice on your ASCIA Action Plan.

If in doubt, give the Anapen® or EpiPen®.

Do not call us for emergency advice.

If you do not have an ASCIA Action Plan and/or an Anapen® or EpiPen® call triple zero (000) for an ambulance.