FPIES - the food allergy you've probably never heard of

What is FPIES?

Food protein induced enterocolitis syndrome (FPIES) is the most severe form of delayed food allergy that is thought to affect as many as one in 300 children.

Essentially, it is a severe, delayed food allergy. The classical FPIES reaction is in infants or young children. Typically, they present one to six hours after they consume the offending food or drink. They present with severe recurrent vomiting, dehydration and marked pale appearance.

Up to 20% of acute reactions result in the child needing admission to hospital for dehydration and 'shock', requiring rehydration intravenously. A lot of children also suffer from diarrhoea and extreme exhaustion as well during reactions. It can be pretty dramatic.

Most children with FPIES have only one or two acute reactors, but often have concurrent non-IgE and IgE- mediated allergies, as well so may have major dietary restrictions. This makes trying new foods very hard. Typically, children do not respond on their first ever ingestion of a food, it is usually after they have been exposed to it two or three times at least.

There is increasing evidence that chronic FPIES (less acute, but ongoing reactions) may be a diagnosis in its own right. Children may present with intermittent vomiting, marked reflux, diarrhoea, abdominal pain, constipation and reduced growth. This is similar to that of other delayed allergies but more severe and usually the child has a couple of acute FPIES reactors as well. Most likely, the condition is part of a spectrum from mild to severe. In severe cases, bloody diarrhoea is common.

It is possible for babies to react to foods their mother has eaten through breast milk, although symptoms are usually less severe than if the food was ingested by the child directly.

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