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What is food protein-induced enterocolitis syndrome or FPIES? And are more babies getting it?

Parents, carers and childcare settings are much more aware of food allergies than they once were. Precautions are taken and emergency plans can be developed for each child at risk of a reaction. But fewer people have heard of food protein-induced enterocolitis syndrome (FPIES). FPIES is a poorly understood food allergy that mostly affects infants. It can be caused by a variety of foods including some not usually associated with food allergies like rice, oats and vegetables. Other causes are more typical of food allergies, like cow’s milk and egg. The most common symptom is profuse, repetitive vomiting one to four hours after eating the food. Reactions can be dramatic and worrying for parents,…

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Articles of Interest

A Systematic Review of Food Protein-Induced Enterocolitis Syndrome

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food-induced hypersensitivity disorder that occurs mostly in infants. Long considered a rare disease, a recent increase in physician awareness and publication of diagnosis of guidelines has resulted in an increase in recognized FPIES cases.

Adult Food Protein-Induced Enterocolitis Syndrome

The underlying pathogenic mechanism of FPIES has yet to be elucidated, thus disease-specific diagnostic biomarkers have yet to be determined and an oral food challenge (OFC) remains the gold-standard for the diagnosis.

Diagnostic and Management Strategies of Food Protein-Induced Enterocolitis Syndrome: Current Perspectives

Food protein-induced enterocolitis syndrome (FPIES) is a form of non-IgE mediated food allergy that presents with delayed gastrointestinal symptoms after ingestion of the trigger food. The data regarding FPIES are sparse, despite being recognized as a distinct clinical entity. This narrative review presents the characteristics of this disorder in the pediatric population, as well-standard diagnostic and management protocols.

Doctors Surprised by Scope of Adult-Onset Food Allergies

New research shows nearly 11% of U.S. adults have food allergies, more than many expected, with shellfish most common among adult-onset ones

Food protein-induced enterocolitis syndrome (FPIES): Beyond the guidelines

Correctly identifying FPIES can be challenging because there are no specific biomarkers for diagnosis and the constellation of symptoms may mimic those of infectious enteritis or sepsis. Management relies on dietary food avoidance, periodic re-evaluations for tolerance with oral food challenges, and management of acute reactions with rehydration and antiemetic ondansetron.

International Consensus Guidelines for the Diagnosis and Management of Food Protein-Induced Enterocolitis Syndrome

The International FPIES Association has a global dissemination plan in place for the guidelines that includes outreach to various clinician groups, including allergists, gastroenterologists, pediatricians, and ER physicians, allied health professionals, nurses, dietitians, as well as parents and relevant advocacy groups.

Non-IgE-mediated food hypersensitivity

Non-immunoglobulin E (IgE)-mediated food hypersensitivity encompasses a wide spectrum of disorders including food protein-induced enterocolitis syndrome (FPIES), allergic proctocolitis (AP), food protein-induced enteropathy (FPE), celiac disease, Heiner syndrome (pulmonary hemosiderosis), and cow’s milk (CM) protein-induced iron deficiency anemia.

Recent trends in food protein–induced enterocolitis syndrome (FPIES)

Food protein–induced enterocolitis syndrome (FPIES) was first described in detail in the late 20th century as a non–IgE-mediated food allergy characterized by delayed gastrointestinal symptoms after ingestion of a trigger food. Although the initial case series reported infants reacting to cow’s milk– and soy-based formulas, we now recognize that FPIES affects patients across the age spectrum.

The challenging diagnosis of food protein-induced enterocolitis syndrome: A case report series

Food protein-induced enterocolitis syndrome (FPIES) is a type of non-immunoglobulin E (IgE)-mediated food allergy. However, in addition to vomiting and diarrhea, IgE-mediated skin or respiratory symptoms may be comorbidities in some patients with FPIES.

Update on Food Protein-Induced Enterocolitis Syndrome (FPIES)

FPIES affects patients from early infancy into adulthood. Any food can be a trigger, and common culprit foods vary geographically and by age. An understanding of the complex underlying immune mechanisms remains elusive, although studies show pan-leukocyte activation, cytokine release, and increased gastrointestinal permeability

‘Thickening’ Is Clue to Acute Food Protein-Induced Enterocolitis Diagnosis

Unlike IgE mediated food allergy reactions where patients have immediate symptoms of hives, breathing problems, abdominal pain, and/or vomiting; patients with FPIES do not have hives or breathing problems and vomiting occurs hours after ingestion. In addition, traditional allergy skin testing is typically negative and medications such as epinephrine and antihistamines are ineffective.

Resources

International FPIES Association

The International FPIES (Food Protein-Induced Enterocolitis Syndrome) Association (I-FPIES) is a 501(c)3 patient organization dedicated to improving the diagnosis, treatment and quality of life for those with FPIES through advocacy, education, support, and research.

The FPIES Foundation

Powered by parents and volunteers, The FPIES Foundation is an all volunteer organization born from the vision of eight families all affected by FPIES, dedicated to changing the lives of future families and the children they support.

American Academy of Allergy, Asthma & Immunology

Food Protein-Induced Enterocolitis Syndrome (FPIES), is a delayed, non-IgE-mediated food allergy typically presenting in infancy or early childhood. In recent years, adult-onset FPIES has also been increasingly recognized. Symptoms of FPIES usually occur one to four hours after ingestion of the food allergen and include repetitive vomiting, along with lethargy, color change and/or diarrhea. Severe cases can progress to dehydration and shock. The main diagnostic criteria for FPIES, is repetitive, projectile vomiting, however in adult-onset FPIES, vomiting is absent in up to 40% of adults, while severe abdominal pain is the most common finding, associated with nausea or diarrhea occurring one to six hours after ingestion of the food allergen.

American College of Allergy, Asthma and Immunology

Food Protein Induced Enterocolitis Syndrome (FPIES) is a type of non-IgE mediated food allergy that can present with severe vomiting, diarrhea and dehydration. Like other food allergies, FPIES reactions are triggered by eating a particular food. The most common triggers include cow milk, soy and grains (rice, barley, oats).