FPIES In Babies: Signs, Symptoms, Causes And Treatment

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Food protein-induced enterocolitis syndrome or FPIES in babies is a rare food allergy affecting the gastrointestinal tract. The condition is also called dietary protein enterocolitis.

The onset of symptoms is often seen within a few hours after consuming the triggering foods. Babies and young children are vulnerable to FPIES, and the triggers may vary in each baby. Profuse vomiting and diarrhea can be seen in babies with FPIES due to intestinal tract inflammation. It is recommended to seek prompt pediatric attention to avoid dehydration and hypovolemic shock complications.

Read on to know the common triggering foods, causes, signs, symptoms, and management of FPIES in babies.

Causes Of FPIES In Babies

The exact cause of FPIES is unknown. The improper response of the immune response to food proteins can cause an allergic reaction and localized inflammation of the intestines. FPIES is not an IgE-mediated reaction, unlike other food allergies. Babies with a family history of atopic disorders are more likely to develop FPIES than others (1).

The syndrome is usually seen in babies who have begun consuming solids. FPIES in exclusively breastfed babies is rare. Although various foods could trigger FPIES, the following foods are common triggers in many babies (2).

  • Cow milk and other dairy products
  • Soy milk and other soy products
  • Cereal grains such as rice, corn, barley, and oats
  • Chicken
  • Eggs
  • Turkey
  • Fish and mollusks
  • Green beans
  • Sweet potatoes
  • Squash
  • Peas
  • Mushrooms
  • Probiotics

Signs And Symptoms Of FPIES In Babies

The severity, signs, and symptoms of FPIES may vary in each baby.

The following are the common signs and symptoms of FPIES in babies (3).

  • Vomiting
  • Diarrhea, often with blood
  • Pallor (pale appearance)
  • Dehydration
  • Lethargy (sleepy appearance)
  • Distended abdomen
  • Reduced body temperature (hypothermia)
  • Low blood pressure (hypotension)
  • Cyanosis (bluish skin)
  • Thrombocytosis (increased platelets)
  • Hypovolemic shock (insufficient fluids in the body)

Dehydration, low blood pressure, low body temperature, and hypovolemic shock requires emergency medical care.

Diagnosis Of FPIES

Diagnosis of FPIES can be challenging since the food allergy may occur a few hours after the consumption of the triggering food. And, by the time the symptoms develop, babies may have eaten other foods, too. Some food items can contain multiple ingredients, and any of those could trigger FPIES (4).

Blood tests during an ongoing reaction could help diagnose FPIES. Supervised oral food challenge tests in a hospital may help identify trigger foods. Standard allergy tests, including blood test or skin prick test (SPT) to measure food IgE antibodies, may not be useful in diagnosing FPIES.

FPIES may mimic the signs and symptoms of sepsis in many babies. Therefore, pediatricians may order tests to exclude this condition.

Treatment Of FPIES

The following treatments are generally considered for babies with FPIES (5).

  • Replace dairy and soy-based infant formula with elemental formula or hypoallergenic formula, such as casein hydrolysate-based formula.
  • Introduce vegetables and fruits instead of cereals and grains if the baby already has FPIES.
  • Introduce one food at a time and wait for three to five days before introducing a new food. Giving one type of food may make it easier to identify the allergen than mixed recipes.
  • Identify and avoid the foods that trigger the symptoms.
  • Steroid treatments are given to reduce the immune reaction (if severe and in hospital).
  • IV fluids are given if the baby has dehydration due to vomiting or diarrhea.
  • If a breastfed baby has FPIES, they should be given formula feed (only under supervision of treating pediatrician).

The treatment options may vary based on the severity of symptoms and the FPIES-triggering food. Pediatricians, allergists, gastroenterologists, and feeding therapists may be involved in babies’ care. It is recommended to seek personalized diet plans since the triggering food may vary in each baby.

These treatment options are aimed at managing the symptoms and reducing the severity of allergic reactions. There is no specific treatment for the condition, so identifying and avoiding triggers on an individual basis is recommended.

Prognosis Of FPIES In Babies

Most babies remain healthy and have normal growth if they are not fed triggering foods. Many babies outgrow FPIES at an early age, and it is not a lifelong condition. Recent studies have shown that most babies with FPIES caused by barley, dairy, or rice outgrow the condition by age three (5). Oral food challenges are often conducted with medical supervision to identify if the baby has outgrown the FPIES.

Some babies may experience FPIES in adolescence and beyond. Proper medical care and a personalized diet plan could help ensure adequate growth in such cases.

Babies with FPIES may have a higher risk of developing atopic disorders, including atopic dermatitis (a chronic inflammatory disorder of the skin), asthma, and allergic rhinitis (hay fever). There might also be a risk of developing gastroesophageal reflux. You may discuss with the pediatrician the prognosis of FPIES specific to your baby.

Frequently Asked Questions

1. Can a baby have FPIES without vomiting?

Vomiting is one of the most common symptoms of FPIES. Hence, it is unusual for a baby to have FPIES without vomiting (6).

2. Does avocado cause FPIES?

Avocado is one of the most commonly reported fruits responsible for the occurrence of FPIES (7).

FPIES is a rare food allergy that affects the gastrointestinal tract of babies. Severe vomiting and diarrhea are one of the distinctive symptoms of FPIES. The good news is, FPIES in babies is not a lifelong condition, and it usually self resolves. Following a diet that is free of the triggering factors and is designed by a certified nutritionist can help you manage the symptoms until the child outgrows the condition. If atopic disorders or FPIES run in your family, you may consider talking to your healthcare provider during pregnancy or after your child is born.

Key Pointers

  • Food protein-induced enterocolitis syndrome (FPIES) is more common in babies with a family history of atopic diseases.
  • Poultry, dairy, fish, mushrooms, and green beans are major FPIES triggers in babies.
  • Babies with FPIES are at a higher risk of developing atopic diseases, such as atopic dermatitis, asthma, and allergic rhinitis.
  • Identify and avoid the foods that cause the symptoms, and introduce one food type at a time, waiting three to five days for any reaction.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Food Protein-Induced Enterocolitis Syndrome; The National Organization for Rare Disorders
2. Introducing Food To The Infant With FPIES; The Children’s Hospital Los Angeles
3. Food Protein-Induced Enterocolitis Syndrome (FPIES); The Children’s Hospital of Philadelphia
4. Food Protein-Induced Enterocolitis Syndrome (FPIES); The American College of Allergy, Asthma and Immunology
5. Food Protein-Induced Enterocolitis Syndrome (FPIES); The Australasian Society of Clinical Immunology and Allergy (ASCIA)
6. Food Protein-Induced Enterocolitis Syndrome (FPIES) Frequently Asked Questions (FAQ); Australian Society of Clinical Immunology and Allergy
7. Food protein induced enterocolitis to banana; American Academy of Allergy, Asthma & Immunology
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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more

Dr. Wayne Hough

(MBChB, MMed, FC Paeds)
Dr. Wayne Hough is a pediatrician currently based in the Northern Suburbs of Cape Town in South Africa. He got his medical degree from the University of Stellenbosch. He then worked at the Tygerberg Children's Hospital before completing his pediatric training and qualification from the South African College of Medicine. Dr. Hough also holds a MMed degree in pediatrics from... more

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