What is FPIES and what do I do if my child has it?
Oct 04, 2024
“Hi Kat, one of the babies in my mums group has just been diagnosed with FPIES. I think she’s about 10 months. Can you go through this with us for your first aid Friday?”
-Lauren
Food Protein Induced Enterocolitis, or FPIES, is a rare but important condition that could affect your baby. Let's breakdown what FPIES is, how to recognise it, and what to do if you think your child has it.
What is FPIES?
First things first, what exactly is FPIES? Well, FPIES is a type of food allergy that usually occurs within the first 2 years of a child’s life, and it primarily affects the digestive system. Now, unlike the typical food allergies that cause immediate reactions like hives or swelling, FPIES causes delayed symptoms, usually within 2 to 4 hours after eating the trigger food. For infants, the most common triggers are cows milk, soy, eggs, chicken and grains like rice or oats, just like this little one from Lauren’s mothers group. But it’s important to know that FPIES can be triggered by virtually any food.
It’s hard to know just how common FPIES is, because it's under recognised and difficult to diagnose. However, The Australasian Society of Clinical Immunology and allergy, or ASCIA, report that in the first 2 years of life, around 1 in 7000 children have FPIES, with this number on the rise.
How does it present?
In FPIES, the body reacts to certain proteins in food as if these proteins were harmful invaders or something. This then leads to inflammation in the gut, causing a range of symptoms.
These symptoms can include:
🔸Repetitive, profuse or projectile vomiting.
🔸Some infants can become pale, floppy and cold.
🔸Sometimes diarrhoea can occur 5-10 hours later.
🔸The diarrhoea along with the projectile vomiting can also lead to dehydration, which in our real little ones can become a medical emergency.
What to do:
If you suspect your child is having an FPIES reaction, it's important to take action immediately.
If your child is vomiting, but it’s not too severe and they are managing to keep down fluids, calling up your family doctor or even using a virtual telehealth service who specialises in paediatrics is probably the way to go. Depending on the situation, you might simply be advised to keep giving fluids to maintain hydration, or you may be prescribed some special mouth wafers (or ondansetron) to help control the vomiting and prevent dehydration. But...
**If your child is vomiting severely, or seems very cold, pale or floppy, this warrants a trip straight to the ED.**
Dehydration can happen super fast in kids, and the younger they are, the more dangerous this can become. FPIES can also mimic other nasty life threatening conditions like sepsis, so it’s really important to rule out these more sinister causes too.
Can I give other allergy medication to help?
I just want to clarify again that FPIES is a different type of allergy to the ones you see causing the skin symptoms and breathing issues, so there is no role for the use of antihistamines or adrenaline autoinjectors such as EpiPens in an FPIES reaction.
How is a diagnosis made?
Making an FPIES diagnosis is quite challenging. It’s usually made based on your baby’s reaction history and symptoms. Some common allergy tests, like skin prick tests and patch tests, aren’t useful for diagnosing FPIES. During the initial reaction, blood tests may be ordered to look for other conditions that have similar symptoms to FPIES, such as infections.
When it's not clear whether your child has FPIES, or when trying to figure out if they've outgrown it, doctors might recommend a medically supervised oral food challenge. This is where your child is given small amounts of the suspected food under close medical supervision to see if it causes a reaction.
How is FPIES managed?
Currently, the only management option for the prevention of an FPIES reaction is to avoid the trigger food, and thankfully, most children, will only have 1 food trigger for FPIES. In other good news, the long term outcome for FPIES is excellent, and most kids will outgrow FPIES before they start school… phew! A plan for when and how to reintroduce the FPIES trigger food/s will be determined by your child’s allergy specialist. This may be done either as a medically supervised oral food challenge or if recommended by your allergy specialist, a re-introduction of the triggering food at home.
Closing thoughts:
So, in summary, FPIES is a rare type of delayed food allergy that affects the digestive system. It’s caused by ingestion of a trigger food, after which digestive symptoms appear between 2 and 4 hours later. If your child has persistent vomiting, or is cold, pale or floppy, they need to be taken to the emergency department immediately to manage dehydration and rule out other nasty conditions such as sepsis. Management involves avoiding the trigger food, and luckily most children outgrow their FPIES by the time they start school.
Worried about choking? Access our FREE choking guide 👇
We won't spam you. Unsubscribe at any time!