What is FPIES?
Food Protein-Induced Enterocolitis Syndrome (FPIES), pronounced F-pies, 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 infant formula fed babies.
FPIES is thought to affect 1 in 7000 children under 2 years of age.
FPIES is different to other food allergies. FPIES:
- Is usually a delayed reaction, occuring 1-4 hours after eating/drinking
- Is a ‘non-IgE mediated allergy’ and is not caused by Immunoglobulin E (IgE) antibodies
- Reactions involve the gastrointestinal system (gut). DOES NOT cause hives, welts, swelling or difficulty breathing (anaphylaxis) and is NOT treated with adrenaline (epinephrine) injectors (such as Anapen®, EpiPen®)
Signs & Symptoms of FPIES
Symptoms are like a stomach bug which starts with severe vomiting (like a fire hydrant) and is often followed by diarrhoea. Symptoms usually start within 1-4 hours after eating the trigger food or drink. These episodes can be very frightening, as some babies also become pale and floppy and feel cold to touch.
Diagnosis of FPIES
If you think your child may have FPIES, please get a referral to see an allergy specialist.
An ASCIA Action Plan for FPIES should be completed by your doctor. FPIES is managed by avoidance of the food allergen that causes the FPIES reaction.
There are no blood or skin tests to diagnose FPIES, so doctors use a patient’s clinical history to make the diagnosis. Sometimes medically supervised oral food challenges are used when the history is not clear. Babies with FPIES may also have other food allergies and/or eczema.
A food allergy dietician can provide information on how to avoid FPIES trigger food/s and assess the diet to make sure it is nutritionally adequate.
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 rarely occurs in fully breastfed babies. When it does occur in breastfed babies, mothers can continue to consume the food that causes FPIES unless there are signs / symptoms of a reaction.
FPIES can occur in adults, but it is uncommon. The most common food trigger for adults is seafood. Symptoms are not usually as severe as in babies and often occurs as abdominal pain.
It is NOT important to avoid foods with Precautionary Allergen Labelling (PAL) statements (such as ‘may contain traces of xx’) as very small amounts of the trigger will not cause an FPIES reaction in most people.
Management and treatment of FPIES
The only management for FPIES is avoidance of the food allergen that causes the FPIES reaction.
FPIES reactions are managed by following your ASCIA Action Plan for FPIES
If a child who has been diagnosed with FPIES has severe vomiting and becomes pale and floppy or cold to touch it is important to call triple zero (000). FPIES reactions are treated by replacing fluids lost through vomiting and diarrhoea. In some cases, medication may be needed to stop vomiting and intravenous fluids (fluids through a drip put in the baby’s arm or foot) required to replace fluid lost.
Adrenaline injectors and antihistamines are not used to treat FPIES. They do not work.
Long term outcomes with FPIES
You should only reintroduce foods that your child has had an FPIES reaction to after a review by your child’s allergy specialist.
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) Frequently Asked Questions (FAQ)