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How Do I Know If My Child Has FPIES?

What is FPIES Syndrome?

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a food allergy disorder that affects the gastrointestinal tract and sometimes causes severe reactions.  It is an uncommon disorder that most often affects infants and young children and occurs following the ingestion of a food trigger. Because the symptoms of FPIES can mimic those of other disorders or illnesses, it is often misdiagnosed and can leave parents frustrated and unsure where to turn.

The Types and Common Symptoms of FPIES

  • Acute FPIES often presents in infancy with repetitive vomiting approximately 1-4 hours after ingestion of the food trigger. In acute reactions, children often appear sleepy, pale, blue, and/or unresponsive, and may also have delayed diarrhea.  FPIES Symptoms usually resolve within about 24 hours of food ingestion and with proper nutrition management, these children often have normal growth.  Severe reactions may lead to dehydration, change in body temperature, and/or blood pressure. The most common triggers for acute FPIES reactions are cow’s milk, soy, and grains – most commonly rice and oat.
  • Chronic FPIES occurs in infancy (usually < 4 months of age) and occurs when the food trigger is ingested on a regular basis, usually daily; such as infant formula. FPIES Symptoms typically resolve within a few days after removing the offending food from the diet. Common FPIES symptoms include chronic/intermittent vomiting, watery diarrhea, and poor growth. Children with chronic FPIES will often have an acute reaction if the food trigger is reintroduced into the diet after a period of avoiding the food. The most common triggers for chronic FPIES are cow’s milk or soy formula.

How is FPIES Diagnosed?

FPIES can be difficult to diagnose because there are no specific procedures or tests for diagnosing FPIES.  An accurate medical history and a description of the reaction are the most important tools for obtaining an accurate diagnosis.  When describing the reaction to your healthcare provider, it is important to include details such as all foods that were eaten and the time they were consumed, as well as the specific FPIES symptoms, when they occurred, and how often they occurred.  Traditional testing used for IgE-mediated food allergies, such as skin prick tests or blood tests are typically negative and may be used to rule out other types of food allergies and further clarify the type of reaction. During an acute FPIES reaction, some lab values may be abnormal such as elevated white blood cell count, neutrophils, eosinophils, and platelets. In both acute and chronic cases, the child may also experience anemia (decreased red blood cell count) or low albumin (protein).

Management of FPIES

During a reaction, it is important to get medical treatment to stabilize blood pressure and treat dehydration. This may require giving fluids through an IV in a medical setting.  Unlike a traditional food allergy, epinephrine is not helpful in treating an FPIES reaction.  Going forward, it will be important to avoid any food triggers to prevent future reactions.  Your healthcare team should provide guidance on how to stay safe while expanding your child’s diet to ensure adequate nutrition and development of good eating skills.

How an Amino Acid-Based Formula Can Help

Meeting nutrition needs for children with FPIES can be a struggle, especially if there are a large number of food restrictions.  Breastfeeding or hypoallergenic formula is recommended for infants with FPIES and since FPIES does not typically resolve until the age of 3 years or later, many children will need a formula beyond infancy.  EquaCare Jr. or Essential Care Jr. can safely fill in the gaps by ensuring adequate nutrient intake during periods of food restriction, food avoidance, or poor weight gain and growth in children over 1 year of age. Learn more about each of these beneficial products by visiting us online today or by calling 1-833-377-2773.

Resources:

  • https://www.jacionline.org/article/S0091-6749(17)30153-7/fulltext
  • https://www.fpies.org/
  • https://fpiesfoundation.org/