What is FPIES?

FPIES is a severe delayed food allergy of the gut, it is understood to be a T-cell mediated response, a Non-IgE Food Allergy in which food is considered a foreign invader and the body fights, or attacks it, until it can violently expel it; although the exact mechanisms are still not well understood.

Symptoms include: profound vomiting (often to bile), diarrhea and/or constipation. These symptoms can quickly lead to: lethargy, low body temperature, low blood pressure and in severe cases, sepsis-like shock. And still yet, many parents report children also experiencing many discomforting symptoms while the body fights this reaction and these can include: extreme stomach pains, excessive gas, runny stools with or without mucus/blood, acid reflux, rashes/eczema, sleep disturbance, and agitation/inconsolable crying.

FPIES is a clinical diagnosis (based on symptoms and history) there is currently no test for it.

This is my definition of FPIES, defined by my own research in: medical journal articles, other families living through FPIES I 'meet' on the support groups and, of course, my own son. You can learn more about my research in FPIES here on this blog, and at The FPIES Foundation website.
Showing posts with label chronic FPIES. Show all posts
Showing posts with label chronic FPIES. Show all posts

Saturday, February 25, 2012

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.....

Saturday, September 24, 2011

FPIES: An Update on Natural History and Review of Management

Food Protein-Induced Enterocolitis Syndrome: An Update On Natural History and Review of Management

I love new articles on FPIES.   The above article was just published in August, and it is FULL of GREAT information.   It is a terrific synopsis of what has been studied thus far in FPIES, and how it is currently best managed.  Dr.Nowak-Wegrzyn has authored some great articles lately and it is exciting to see.   Most exciting to see is the table on page 2 giving descriptions for Chronic and Acute FPIES.   My son suffered from chronic FPIES which made his diagnosis more difficult to come to, as his acute reactions weren't happening as frequently as his chronic reactions.   It was a very muddy picture, it still is a muddy picture because his body reacts chronically as we seek to introduce foods- he "builds" to a reaction vs. having an acute shock reaction from the first 1/2tsp of food.  The acute shock reactions have been what has been studied over the past 20yrs. (rightly so due to their severity), now it appears groundwork is being laid to further study and define Chronic FPIES that so many other FPIES kids experience as well.

This is a great article, giving good descriptions for the history of FPIES and definitions of what is known about diagnosis and management of it.    It really is exciting to see so much being studied, and further recognized in the past year.  

Sunday, April 3, 2011

Gut Homeostasis

The functioning of the gut is important to our overall health.
Indeed, we now know that intestinal flora plays an important role in health: stimulating the immune system, protecting the host from invading bacteria and viruses, aiding digestion and assimilation of food. Yet, the importance of these bacteria in the gastro-intestinal “GI” tract has been neglected for a long time, while the focus was merely placed on enteric pathogens and other factors leading to gastrointestinal "disorders".Custom Probiotics

Gut microflora is specific to each individual, established at birth- resident flora does not change substantially from birth.   However, many things in life can change the density,numbers/concentration, and ratio of good to bad microflora.  These things include: diet, antibiotics, illness, stress, infection, the list goes on but these are the main effectors.  To achieve homeostasis, there needs to be a balance of good gut flora to bad. "Lactobacilli and Bifidobacteria, should predominate, presenting a barrier to invading organisms. Around 85% of the intestinal microflora in a healthy person should be good bacteria and 15% bad bacteria. The greater the imbalance, the greater the symptoms" Custom probiotics

You'll notice my above links, a fellow FPIES mom shared the link in her search for probiotics for her child.   I typically don't quote websites that are also selling something and proceed with caution with their information (as I just need to re-research it to be sure it is medically sound information) but the above information is good information from their site, which I found easy to read through (although they are selling something and although it looks like a promising probiotic, as always check with the manufacturer for safe ingredients first!).   The reason I have bookmarked their site is because they have a GREAT illustration of the intestines and it's tie to the immune system.  So, if you'd like a look at that- visit this site and scroll down the page a few paragraphs. 

It shows the villi and crypt of the intestines.  The villi and crypt can be damaged in severe/chronic FPIES inflammation, therefore causing further cascading problems of illness from increased intestinal permeability (leaky gut) due to the inflammation opening "holes" in the intestine, thereby causing further damage, deficiencies and mostly allergies/intolerance's as proteins "leak" into the blood stream (via the lymph).   Villi damage can also lead to nutritional deficiencies and weight loss as this is where nutrients are picked up from the broken down food molecules. 

Intestinal flora forms a natural barrier to pathogens and also work together with the GALT (intestinal immune system within the GI tract made of lymphoid cells), comprised of Peyer's Patches (which facilitate the beginning of the immune response in the GI tract), Paneth cells (control microbes) and dendritic cells (micro flora communication).   When the antigenic presenting dendritic cell (where micro flora have their role) activates the lymphocytes,  it leaves the mucousa via the lymph and enters the blood stream via the thoracic duct.  The activated lymphocytes then travel back to the gut and can colonize in the same mucousa or other mucousal sites along the GI tract.    This is where the Tmemory cells are then stored and activated upon re-exposure to trigger (antigen) proteins (and likely why the re-exposure can be a more intense response because of the recognition from previous activated lymphocytes. 

Probiotics can help manage that balance once it has been established (past infancy).   Probiotics have antimicrobial effects (pathogens, toxins), maintain intestinal epithelium (barrier), and regulate the immune system via the GALT (inflammatory responses to allergens and other inflammatory substances). 

It is clear the balance (homeostasis) of micro flora in the gastrointestinal tract is important to immune responses.

Tuesday, March 22, 2011

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?