What is Food Protein Induced Enterocolitis Syndrome or FPIES? And do more babies get it?

Parents, carers and childcare providers are much more aware of this food allergies than they once were. Precautions are made and contingency plans developed for any child at risk of a reaction. However, fewer people have heard of food protein-induced enterocolitis syndrome (FPIES).

FPIES is a poorly understood food allergy that primarily affects infants. It can be caused by a variety of foods, including some not typically associated with food allergies, such as rice, oats, and vegetables. Other causes are more typical of food allergies, such as: B. cow’s milk and egg. The most common symptom is severe, repeated vomiting one to four hours later eat the food.

The reactions can be dramatic and worrying for parents: infants become pale, lethargic (drowsy), and limp. In severe cases, infants develop dehydration and low blood pressure. Because of the variety of diseases that can cause these symptoms and the time lag between ingestion of a triggering food and onset of symptoms, the diagnosis is often not made when a reaction first occurs.

Until recently, FPIES was thought to be rare, but new evidence suggests it may be more frequently than previously thought. There has also been a significant research effort in the last decade to understand which part of the immune system is responsible for triggering FPIES responses in order to develop better tests for diagnosis and treatment.

What causes symptoms?

We don’t currently know much about the immune deficiency that causes FPIES.

FPIES is classified as Non-IgE mediated food allergyunlike other types of more common food allergies like peanut allergy where reactions are caused Allergy Antibodies that can be detected in the blood.

This also means that medications used to treat these types of allergies (like EpiPens and antihistamines) won’t work for FPIES. Current Studies suggest that another part of the immune system, called the innate system, may be involved. This system is that of the body first line of defense against potential intruders. It contains Bacteria that repel insects or injury rather than cells that adapt to respond to threats.

Missed Cases?

The symptoms of FPIES can be mistaken for other conditions, such as gastroenteritis (“gastro”), torsion of the bowel, or serious blood infections. This can delay diagnosis.

Unlike most other types of food allergies, where the reaction is due to allergy antibodies, there is no blood test to diagnose FPIES. The diagnosis is based on a careful clinical history and may require a specialist oral feeding challenge. This may consist of eliminating foods suspected of causing a reaction from the menu and then gradually reintroducing them at planned stages under medical supervision.

How common is FPIES and is it becoming more common?

Because it is underrecognized and difficult to diagnose, there are estimates of FPIES prevalence vary significantly – between 0.015% and 0.7% of infants.

Although data are sparse, some studies report an increase in FPIES rates. A study using hospital data from Australia and New Zealand reported Hospital admissions had tripled for infants with symptoms consistent with a potential FPIES between 1998 and 2014.

Increasing awareness of FPIES and improvements in diagnosis mean that the number of FPIES diagnoses may increase without an actual increase in the disease. Different estimates of FPIES rates between countries (e.g. 0.15% in Australia and 0.7% in Spain) may be due to actual differences or variations in diagnosis and reporting. More research is needed to understand these differences.

What foods trigger FPIES?

Different foods appear to commonly cause FPIES in different countries. Australia has the most rice reported FPIES trigger, often with cow’s milk, soy and eggs. Cow’s milk is the most commonly reported trigger United States and Europe. Fish is a common trigger in the Mediterranean Countries and increasingly reported as a cause of FPIES in older children Adult. It is unclear what causes these differences, which may only be partially explained by differences in infant feeding and weaning practices across countries.

Reactions often first appear in infancy when a new food is introduced, either at the first exposure or after the first few exposures. Most affected babies only react to a single food, although some foods cross-react. This means that infants similar reaction to related foods such as grains (rice and oats); cow’s milk and soy; fish and shellfish. People with FPIES need to avoid the foods that trigger FPIES reactions, but there’s often no need to avoid other, unrelated foods.

Most children will outgrow FPIES within the first few years of life. There appear to be differences in the speed at which FPIES subside depending on the triggering food, for cow’s milk and grain FPIES solve faster as egg and seafood FPIES. Adults can also develop FPIES, but this is the case less common.

What to do if you suspect you or your child have FPIES?

If you think you or your child may have FPIES, talk to your doctor. They may recommend referral to an allergist for evaluation.

The next step could be the development of one action plan for an FPIES reaction. For serious reactions, such as an infant becoming dehydrated or limp after vomiting or diarrhea, seek specialist help at the nearest hospital casualty department.

Jennifer KoplinGroup Leader, Child Allergy and Epidemiology, The University of Queensland; Diana CampbellProfessor, Child and Adolescent Health, Faculty of Medicine and Health,, University of SydneyAnd Eric LeeDepartment of Allergy and Immunology at Westmead Children’s Hospital, University of Sydney

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