FPIES is a delayed adverse reaction to food that typically affects infants and young children. It can be quite severe and even life-threatening. The most common symptoms of FPIES include repetitive vomiting, profuse diarrhea, and, occasionally, dehydration. These symptoms can lead to lethargy (acting listless or not responsive), lowering of core body temperature and low blood pressure. Symptoms of FPIES are not like the typical food allergy. The symptoms may not be immediate and the trigger foods are not revealed on standard allergy skin or blood tests.
In infancy, FPIES reactions are usually caused by cow’s milk protein formula or occasionally by soy. Proteins in breast milk may also cause symptoms in some infants. For older infants/toddlers experiencing FPIES with solid foods, rice and oats are the most common triggers. Other common FPIES triggers include barley, green beans, peas, poultry, soy, squash, and sweet potatoes. However, any food protein can be a trigger!
FPIES is usually diagnosed through a careful history of the characteristic symptoms and exclusion of other similar disease states. An allergist/immunologist and gastroenterologist should be involved in making the diagnosis and treatment plan. Although Atopy Patch testing (APT) is often used for FPIES patients, it is not a validated test for FPIES diagnosis. The most definitive test is a medically supervised oral food challenge (OFC)-where the suspect food is given to the child in a controlled clinical environment.
FPIES reactions can be severe. It is important to get to prompt medical attention where treatment, such as intravenous fluids to treat dehydration, can be given quickly. FPIES usually resolves with time on its own. The FPIES patient will need to be closely followed by the doctor to determine which foods are safe to eat and when it may be time to determine if FPIES has resolved. With proper medical attention and a personalized dietary plan to ensure proper nutrition, children with FPIES can lead a happy and healthy life. The Board Certified Allergists/Immunologists at AAIR have extensive experience in the management of FPIES, and work closely with primary care providers and digestive health specialists to care for patients with this rare but serious condition.
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