About FPIES

From The FPIES Foundation

About FPIES

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a type of food allergy affecting the gastrointestinal (GI) tract. Classic symptoms of FPIES include profound vomiting, diarrhea, and dehydration. These symptoms can lead to severe lethargy, change in body temperature and blood pressure. Unlike typical food allergies, symptoms may not be immediate and do not show up on standard allergy tests. Furthermore, the negative allergy evaluation may delay the diagnosis and take the focus off the causative food. Nonetheless, FPIES can present with severe symptoms following ingestion of a food trigger.  Read more.....

A Case of Severe Atypical Food Protein Induced Enterocolitis Syndrome

I recently read this article: A Case of Severe Atypical Food Protein Induced Enterocolitis Syndrome (abstract here).

It is a short article published in Allergy journal in August 2010 about a case of a severe reaction to cow's milk in a 4yr.old boy.  "The article highlights the potential severity of this condition and its capacity to present beyond infancy".

This 4yr.old boy, with a history of developmental delays had been receiving his extensively hydrolyzed cows milk formula via tube feedings since infancy.  He had ongoing eczema and a history of GERD; but otherwise had no other indications of allergy past infancy.   He was given unhydrolyzed cows milk formula in an overnight feed, within 2hours he was showing discomfort and began to have frequent watery stools (every 10-15min), which progressed to bloody stools within 2hrs.,so the feedings were stopped, and he was also having significant shortness of breath so was taken to the ER.

The article goes on to describe how he presented in the ER without fever (actually had low body temp), had low blood pressure and also acidotic and significant shortness of breath.  Further labs also revealed increased methaemoglobin, neutrophils and platelet levels.  He was treated for his symptoms of presumed septicemia and remained in the hospital; although extensive work up could not find a source for his symptoms.  Follow up endoscopy was performed 3 weeks following this episode and biopsy findings revealed gastritis and eosinophlic infiltrate in the colon.  He was resumed on his tube feedings with an elemental formula. 

The conclusion of the article highlights that FPIES is a "complex of vomiting, diarrhea, and systemic inflammatory response because of Non-IgE food allergy". The authors note that this case is outside of the published criteria for typical FPIES but that it illustrates the severity of this type of allergy and that it is possible to have an FPIES response beyond infancy.  The authors conclude the article with a very important message about FPIES, "FPIES is frequently misdiagnosed, and children often have several acute presentations before the diagnosis is established. In view of its potentially fatal clinical course and the recent increase in prevalence suggested by others, it is critical to consider the diagnosis in young children presenting with acute onset of gastrointestinal symptoms or shock".

A Rare Food Allergy Doctors Know Little About

Med Watch: A rare food allergy doctors know little about.

Another FPIES family in the news.   The family's story is something that hits close to home for many FPIES families...."I googled baby vomits rice cereal"- wow, did we all do that?  Because who in the heck is allergic to rice?  FPIES kids are, it's bizarre but very real, and scary.   This mom's account of her daughter's reaction is an emotional account for any FPIES parent, as her daughter is one of the numbers of FPIES that went into full shock with the ingestion of rice.  The statistics show that ~20% of FPIES children do (although I would dispute that number to be much higher based on what is shared in support groups).  The interview is a window into an FPIES families world. 

The news report includes an interview from the family physician who helps manage their daughters care, with emphasis on the need for ruling out other conditions, and the symptoms caused from an FPIES reaction. 

Thank you to Ginny and her mom for a great awareness story on FPIES!

Managing Allergy

What a great find!  An entire book to view, and a great resource on Allergy in general! Find it here: Managing Allergy.

Chapter 10 (pg. 157) is the overview on Food Allergy.  Each chapter is divided to describe allergies in depth, all complete with their own reference section!   

On pg. 165, the discussion of FPIES.   It defines it in a table (of IgE, Non-IgE and mixed allergy) of disease manifestations, which include:"Irritability, excessive, vigorous vomiting and diarrhea a few hours after ingestion of the allergen, hypotension, lethargy, hyponatremia, acidosis, a "left-shift", and methemoglobinaemia may occur.  Stool smears may reveal blood, leukocytes or eosinophils.   A more indolent course, with failure to thrive, hypoalbuminaemia, chronic vomitting and diarrhea may occur for young infants chronically eating the allergen." 

It continues and devotes a paragraph on pg.167 for an action plan, ER treatment, resolutions of FPIES, triggers, and recommendations for challenges (.3-.6g of protein per kg of body weight to be fed in 1-2 doses...with IV inserted prior). 

I think it is a good synopsis of FPIES (especially for a book copyrighted in 1999).   I like that it gives both classic and chronic symptoms in the disease manifestations table.  Putting together more of what is known about FPIES, from research and from moms is what will help guide what should be researched next.  But if this much was known in 1999....why don't more doctors already know about it?