What is FPIAP?
FPIAP is a type of non-IgE-mediated food allergy. Non-IgE-mediated food allergy is often referred to as gastrointestinal (gut) food allergy. For this reason, it is sometimes confused with food intolerance. Reactions happen because of an abnormal immune response to food proteins and are generally delayed (1 to 72 hours after eating or drinking the food).
A non-IgE-mediated food allergy cannot be diagnosed with a skin prick test or IgE antibody blood test. A diagnosis can only be made after an elimination diet.
FPIAP occurs because of inflammation in the large intestine caused by allergy.
FPIAP usually occurs in babies who are breastfed but can also occur when cow’s milk (dairy) or soy-based formula are started.
Signs of FPIAP
- Blood and mucus in stools
- Diarrhoea
Signs usually start in early infancy. Babies with FPIAP are otherwise healthy and growing well.
What foods cause FPIAP?
The most common food triggers are cow’s milk and soy.
Less common food triggers are egg, wheat and corn.
Diagnosis of FPIAP
Skin tests and blood tests are not helpful to diagnose babies with FPIAP.
Medical causes of blood in the stools should first be excluded by the doctor.
The suspected trigger food/s should be removed and when symptoms have settled, put back into the diet to confirm the diagnosis.
Management of FPIAP
FPIAP is usually managed by the removal of the food trigger – most commonly cow’s milk (dairy) and often soy – from the breastfeeding mother’s diet and from the baby’s diet if on formula (and solids).
A paediatric allergy dietitian can help with a nutrition assessment and advice.
For breastfed babies:
Symptoms usually improve 2-3 days after removing the cow’s milk (and/or other trigger) from the breastfeeding mother’s diet.
For formula fed babies:
Speak to your doctor or paediatric allergy dietitian about the most appropriate infant formula.
Improvement is usually seen in 3-7 days, but maybe up to 2 weeks.
Long-term outcomes with FPIAP
50% of babies will grow out of FPIAP by 6 months of age and 95% of babies by the age of 9 months.
It is recommended to reintroduce the food trigger to the mother’s or baby’s diet six months after it was removed or at 12 months of age. For babies with severe symptoms, such as blood-stained diarrhoea, the trigger foods should be introduced under the supervision of the treating doctor or a paediatric allergy dietitian.
Useful links
ASCIA has further information on Food Protein-Induced Allergic Proctocolitis (FPIAP)
ASCIA has a Management Plan for Delayed Allergic Reactions to foods, including FPIAP and FPE