Food Protein-Induced Enterocolitis Syndrome (FPIES)

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Food Protein-Induced Enterocolitis Syndrome (FPIES) is a rare disorder, mostly affecting infants (0-3 years) and young children (3-10 years), which occurs when foods that harm the gastrointestinal tract are taken. FPIES is an alarming condition in which its patients may be diagnosed with “failure to thrive”, although it is hardly life-threatening. It is caused by […] Read More

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Food Protein-Induced Enterocolitis Syndrome (FPIES)

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a rare disorder, mostly affecting infants (0-3 years) and young children (3-10 years), which occurs when foods that harm the gastrointestinal tract are taken. FPIES is an alarming condition in which its patients may be diagnosed with “failure to thrive”, although it is hardly life-threatening. It is caused by severe allergic reactions to certain foods, which do not occur till after eating. FPIES is pronounced “ef-pies”. Food protein-induced enterocolitis syndrome resembles a stomach bug. It is a food allergy that can claim lives in some cases. FPIES causes the small and large intestine to become inflamed as a result of undigested foods which can cause the disorder. FPIES is not caused by Immunoglobulin E (IgE)–an antibody manufactured by the immune system which causes allergic reactions when it travels to cells that release chemicals, though children usually have both reactions at the same time. Children with FPIES can have other allergies such as eczema and asthma.  TRIGGERS OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) The food allergens that trigger food protein-induced enterocolitis syndrome include the following:
  • Chicken, turkey, and other poultry products
  • Fish
  • Breast milk (in rare cases), soymilk, cow milk, and other milk products.
  • Rice, oats, barley, and other grains and cereals.
  • Eggs
  • Cheese
  • Custard
  • Sweet potatoes 
  • Peas
  • Squash
  • Vegetables
Children with FPIES to oats can also have been allergic to rice, those with allergies to turkey can also be allergic to other poultry products, and those with allergies to soymilk can also be allergic to other milk products. DIAGNOSIS OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) Only FPIES has occurred more than once, then it may be easier to diagnose the disorder. When you suspect your child/ward has symptoms of FPIES or related signs, visit your doctor immediately. Your doctor may ask you the following questions before commencing with diagnosis:
  1. What are your child’s/ward’s symptoms?
  2. Does your family have a history of allergies?
No lab and skin tests have proven to help diagnose food protein-induced enterocolitis syndrome. If your doctor suspects FPIES, he may do the following for diagnosis:
  • Atopy Patch Testing
APT involves placing the food allergen in a metal cap and leaving it on the skin for 2 days. Afterward, the skin is watched scrutiny for symptoms in the following days after removal.
  • Oral Food Challenge
OFC involves introducing fouds from similar food groups into your child’s duet for the first time. It can help check if a child has outgrown FPIES. TREATMENT OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) There are no permanent treatments for FPIES or treatments aimed at curing the condition. However, some treatments can manage the symptoms which in turn manages the condition. It is also important to remember that many children outgrow FPIES by the age of 3 to 4. When your doctor confirms that your child has food protein-induced enterocolitis syndrome, he will go on to suggest the following to manage the condition:
  1. Removing the offending food allergens from your child’s diet. This can lead to the fading of the signs related to FPIES. 
  2. Breastfeeding if your child is still an infant.
  3. The use of anti-inflammatory medications to calm the swelling of the gastrointestinal tract and some other symptoms.
  4. The administration of corticosteroids.
  5. Intravenous fluids to help severe dehydration.
NUTRITIONAL MANAGEMENT OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) With FPIES, your child’s diet and food have to be monitored to enable better management till your child can outgrow the allergies. This management comes in stages, letting him/her go on a journey of nutrition from the food he or she has to avoid and as the allergies are controlled, unto the ones which can be adequately managed, and then unto the forbidden ones (called the “reintroduction stage”). Stage 1 (Foods “Advisable” to Eat) In this stage, your child is still struggling with severe FPIES reactions and therefore needs to abstain from eating certain foods.  The foods most suitable to eat may include: Vegetables:
  • Parsnip
  • Broccoli
  • Cabbage
  • Beetroot
  • Spinach
  • Tomato
  • Zucchini
  • Turnip
Fruits:
  • Blueberries
  • Strawberries
  • Watermelon
  • Plum
  • Peach
  • Apricot
Grains
  • Quinoa
  • Sorghum
  • Millet
  • Amaranth
  • Buckwheat
  • Rye
Meats and Nuts
  • Lamb
  • Pork
  • Tree nuts
  • Seeds of appropriate texture
Stage 2 (Manageable Foods) At this stage, there has been progressing and the allergic reactions have been checked to be minimized. This should be confirmed by your doctor. Foods advised to be introduced at this stage include: Vegetables:
  • Pumpkin
  • Green beans
  • White (Irish) potatoes
  • Carrots
  • Lentils
  • Squash
  • Mushroom
Fruits:
  • Apple
  • Pear
  • Orange
  • Avocado
  • Melons such as rockmelon
Grains
  • Wheat
  • Maize (Corn)
  • Barley
Meat and Peas
  • Beef
  • Peanut
  • Chickpeas
Stage 3 (Reintroduction Foods) This stage comes 12 months after managing FPIES and there is a confirmation by your doctor that your child has recovered from the condition. The foods to be introduced at this stage include: Vegetables:
  • Sweet potato
  • Green peas
Fruits:
  • Banana; regarded as the most FPIES fruit.
Grains:
  • Oats
  • Rice
Meats and Legumes:
  • Turkey
  • Chicken
  • Fish and other seafood
  • Eggs
  • Soy
  • Tofu
Cow Milk and Other Milk Products:
  • Cheese
  • Yogurt
  • Custard
SPECIALTY Many specialists are involved in the treatment and management of food protein-induced enterocolitis syndrome (FPIES). The doctor you are expected to first meet for the diagnosis of FPIES for your child is a “Pediatric Enterologist”.  Another specialist is a “Pediatric Allergic-immunologist”, who helps find the causes of your child’s FPIES and the right treatments to manage the symptoms.

Symptoms

SYMPTOMS OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES)

The signs and symptoms of food protein-induced enterocolitis syndrome are often similar to a stomach bug, but there are some distinctive signs.

The symptoms of FPIES include:

  • Nausea coupled with diarrhea
  • Frequent throwing-up/vomiting
  • Dehydration; excessive thirst
  • Shallow breathing
  • Fatigue, weakness, tiredness.
  • Cold skin
  • Pale skin
  • Skin discoloration
  • Weakened pulse
  • Confusion
  • Anxiety
  • Shock and fainting
  • Low/fluctuations in blood pressure.
  • Fluctuations in body temperature.
  • Loss of weight
  • Undergrowth (over some time)
  • Encephalitis lethargica; sleeping sickness.
  • Low levels of oxygen in the blood
  • Thrombocytopenias leading to blood clotting.
  • Swelling of the abdomen.

Rare symptoms include:

  • Atopic Dermatitis

This is a situation in which the skin develops a chronic inflammatory disorder. They come into being when one's immune system responds absurdly to environmental allergens, such as cigarettes and pollen.

  • Allergic Rhinitis (Hay Fever)

This causes itchy, watery eyes, sneezing, and other signs. It occurs all year or seasonally (in some cases).

  • Asthma

This happens when a person's airways are instructed making breathing a difficult task.

  • Failure to Thrive

FTT is the inability to maintain growth, usually during childhood. Apart from stunted growth, it can cause:

  • Poor sucking
  • Hard feeding
  • Weak crying
  • Floppy muscles
  • Poor physical movement
  • Lack of vocal sounds
  • Social disorders such as not smiling.
  • Poor head shape.
  • Poor mental skills.

Once you notice any of the above-mentioned signs, rush your child or ward to the hospital for diagnosis and treatment.

Causes

CAUSES OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES)

You are likely to gain the disorder of FPIES if you eat allergens and if your body (via IgE) improperly responds to proteins in specific foods. 

In 40% of cases of FPIES, patients are allergic to milk. As odd as it seems, rice is the most solid food associated with FPIES. In 70% of cases of food protein-induced enterocolitis syndrome, patients have allergies to one or two foods and these foods trigger the reactions.

FAQ

How long does an FPIES episode last?

An FPIES episode usually begins with profuse vomiting, normally around 2 to 4 hours after ingesting the trigger foods. Then, it is often accompanied by diarrhea, sometimes bloody, lasting for several days. Severe hydration comes along in the process.

Do babies outgrow FPIES?

Yes. Fortunately, food protein-induced enterocolitis syndrome foes do not last for life. Most children outgrow FPIES by ages 3 to 4.

Does FPIES run in families?

No. Food protein-induced enterocolitis syndrome is not a hereditary disease but just a mere disorder that goes away after some minor management treatments or with age. 

It mostly affects children (infants), after which it disappears. But in rare cases, FPIES develops in adolescents and adults as an allergic reaction to shellfish or any other seafood.

Can you have FPIES without vomiting?

It is almost impossible to get through an episode of food protein-induced enterocolitis syndrome without throwing up. The early phase of FPIES is characterized by nausea. 

Can pumpkins cause allergic reactions in babies?

Reactions can come up when eating pumpkins because some pumpkins tend to be itchy. However, there are no prior reactions to eating pumpkin.