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FPIES (Food Protein-Induced Entercolitis Syndrome)

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Food Protein-Induced Enterocolitis Syndrome in Charlotte

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a non-IgE-mediated food allergy that impacts the gastrointestinal system. Most prevalent in infants and young children, this food allergy causes symptoms like vomiting and diarrhea. If severe enough, these symptoms can lead to hospitalization.

At Carolina Asthma & Allergy Center, we know how scary it can be to see your child so ill. That’s why our board-certified allergy specialists in Charlotte are dedicated to providing families with tailored solutions. If you suspect your child may have FPIES, we are here to walk you through diagnosis and treatment.

How to Request an Appointment

Every day, FPIES is mistaken for viral gastroenteritis, sepsis, or another illness. These misdiagnoses make it more difficult for children to receive the compassionate and comprehensive care they deserve. Fortunately, our medical professionals understand how to diagnose and treat this complicated condition. 

To schedule an appointment with our team, contact us online or call 704-372-7900. Our staff will reach out as soon as possible to find a convenient date and time for your visit. 

During the appointment, an allergist will carefully review your child’s medical history, conduct a physical examination, and perform any necessary allergy tests to determine the presence of FPIES. Based on this diagnosis, your child’s allergist will develop a personalized treatment plan.

What is Food Protein-Induced Enterocolitis Syndrome?

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a type of non-IgE-mediated food allergy that affects the gastrointestinal system. This pediatric allergy typically emerges in infancy. Older children and adults can develop FPIES, but it’s very rare.  

With most food allergies, individuals experience a reaction immediately after eating. However, FPIES is characterized by delayed symptoms that occur one to four hours after consuming offensive foods. 

Though most children outgrow FPIES by age three, it’s still important to meet with an allergy specialist. This medical professional can create an appropriate management plan and help you monitor your child’s growth, development, and potential changes in tolerance over time. 

What Causes Food Protein-Induced Enterocolitis Syndrome?

Most food allergies happen when the immune system mistakenly identifies food proteins as harmful and produces an antibody called immunoglobulin E (IgE). Upon subsequent exposure to the same food, the immune system releases histamine and other chemicals, which trigger symptoms such as hives and swelling.

Comparatively, non-IgE reactions engage a special type of white blood cell called T cells. When these cells are activated by a trigger food, they cause intestinal inflammation, vomiting, diarrhea, and other troublesome symptoms.

Symptoms of Food Protein-Induced Enterocolitis Syndrome

FPIES can be categorized into two main forms: acute and chronic.

Acute FPIES

Acute FPIES is characterized by severe gastrointestinal symptoms that occur one to four hours after ingesting the trigger food. These symptoms include: 

  • Repetitive, profuse vomiting
  • Diarrhea (sometimes bloody)

Children may also experience:

  • Lethargy
  • Dehydration 
  • Cold, clammy skin
  • Irritability 
  • Food refusal 
  • Changes in blood pressure and body temperature

In some cases, acute FPIES can cause shock—a critical condition characterized by an inadequate supply of oxygen. Symptoms of shock include:

  • Significantly fast or weak pulse
  • Pale or blanched appearance 
  • Rapid breathing
  • Confusion or unconsciousness

If your child experiences any of the symptoms above, call 911 immediately. Since FPIES doesn’t trigger a histamine response, an epinephrine shot (or EpiPen) will not help. However, medical professionals can administer intravenous fluids and anti-vomiting medication to address dehydration.

Chronic FPIES

Unlike acute FPIES, chronic FPIES is an ongoing or continuous condition with milder but persistent symptoms, such as:

  • Chronic diarrhea
  • Abdominal discomfort
  • Food refusal 
  • Nutritional deficiencies 
  • Failure to gain weight
  • Developmental delays (in young children)

Common FPIES Triggers

Though FPIES can be triggered by a broad range of food proteins, the most common include those found in:

  • Cow’s milk
  • Soy
  • Cereal grains, such as rice and oats
  • Eggs
  • Chicken, turkey, and fish

Interestingly, FPIES doesn’t always manifest upon the first exposure to a trigger food. It may take a child consuming a new food two or three times to experience symptoms.

Additionally, some patients find that reactions are dose-dependent. That means a small amount of a trigger food will not cause symptoms, but a larger amount will.

Breastfeeding a Child With FPIES

If a breastfeeding mother consumes foods that are known triggers for her infant, the proteins from those foods may be present in her breast milk. That said, mothers of breastfeeding infants with FPIES should work closely with allergists to develop a safe, nutritious diet plan.

How to Diagnose Food Protein-Induced Enterocolitis Syndrome

Since FPIES symptoms occur hours after eating, it can be very difficult to diagnose. To further complicate matters, FPIES cannot be identified using skin prick tests or common blood allergy tests such as RAST and ImmunoCAP. 

The oral food challenge—a diagnostic procedure in which patients consume their suspected trigger food in a clinical setting—is also a non-option for many infants and young children due to dehydration risk. 

Instead, the allergist will gather information regarding your child’s medical history, symptoms, and dietary habits. If FPIES is suspected, an elimination diet may be initiated. This involves removing suspected trigger foods to observe whether symptoms improve.

The allergist may also recommend a skin prick test. Though this test cannot diagnose FPIES, it can be used to rule out IgE-mediated food allergies.

How to Treat and Manage Food Protein-Induced Enterocolitis Syndrome

Currently, there is no cure for FPIES. Instead, patients must manage their condition through strict avoidance of trigger foods. 

A board-certified allergy specialist and dietician can work hand-in-hand to determine which foods to swap in your child’s diet. If your child is allergic to milk/soy formula, for instance, the medical team may suggest a hypoallergenic, casein hydrolysate-based formula instead. Or, if your child is allergic to cereal grains, the allergist may suggest certain fruits and vegetables. 

Your child’s allergist will also help you establish emergency protocols. These protocols outline specific steps to take in case of accidental exposure to trigger foods, including when to administer fluids, when to seek medical attention, and how to manage symptoms at home.

Medications for FPIES

There are no medications on the market that specifically treat FPIES. However, your child’s allergist may prescribe:

  • Anti-vomiting medication to prevent dehydration in case of accidental exposure
  • Steroids to manage inflammation in cases of severe FPIES reactions
  • An over-the-counter probiotic to support gut health

How to Reintroduce Trigger Foods

Since most children outgrow FPIES by the age of three, your child’s allergy specialist may recommend reintroducing trigger foods. This process may involve a medically supervised oral food challenge or your child’s allergist may recommend gradual reintroduction at home.

Tips for Parents of Children With FPIES

Caring for a child with FPIES can be challenging. However, with proper guidance and support, parents can effectively manage their child’s symptoms.

Some helpful tips include:

1. Maintain a Detailed Food Journal

Keep a record of your child’s diet, including ingredients and reactions. Share this journal with your child’s allergist to aid in diagnosis and management.

2. Prepare for Emergencies

Work with your child’s allergist to create an emergency plan just in case a trigger food is accidentally consumed.

3. Communicate With Caregivers

Educate family members, teachers, babysitters, and other caregivers about FPIES. Clearly outline which foods they should avoid feeding your child and what to do in case of accidental exposure.

4. Monitor Growth and Development

Since many children with FPIES struggle with nutritional deficiencies, keep a close watch on your child’s height and weight. You should also be mindful of if and when they hit developmental milestones.

5. Seek Emotional Support

Recognize the impact FPIES has on your family’s daily life and find healthy ways to cope. Joining a FPIES support group, for instance, can help you connect with other parents.

Summary

Food Protein-Induced Enterocolitis Syndrome can be an overwhelming condition to manage alone, especially as the parent of a young child. Luckily, the healthcare professionals with Carolina Asthma & Allergy Center are here to help you navigate the diagnosis and treatment process. 

To take the first step toward a comprehensive healthcare solution, contact us online or call 704-372-7900 to schedule an appointment.

Food Protein-Induced Enterocolitis Syndrome FAQs

How do you treat Food Protein-Induced Enterocolitis Syndrome?

The primary treatment of FPIES is strict avoidance of the trigger food.

How long does an FPIES episode last?

An acute FPIES episode usually lasts no more than 24 hours.

What triggers Food Protein-Induced Enterocolitis Syndrome?

Episodes of Food Protein-Induced Enterocolitis Syndrome are commonly triggered by cow’s milk, soy, cereal grains, eggs, and certain meats like chicken, turkey, and fish.

When should I go to the ER with FPIES?

If your child is experiencing symptoms of shock (e.g., fast or weak pulse, pale or blanched appearance, rapid breathing, confusion, or unconsciousness), call 911 right away.

Do kids outgrow FPIES?

Yes. Most children outgrow FPIES by age three.

Can adults get FPIES?

FPIES can occur in older children and even adults, but it’s very rare. 

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