Food protein-induced enterocolitis syndrome (FPIES) is a condition in which eating certain foods produces severe vomiting and diarrhea in infants and children, mostly under the age of 3 years old. It is not a food allergy but has some of the same symptoms. It most commonly occurs after drinking cow’s milk or soy milk, although it is known to occur with solid foods, as well. The symptoms begin several hours after the food is eaten and can subside if the food is not eaten again. Most children stop experiencing FPIES around age 3 but, in rare instances, these children can go on develop actual food allergies or other problems later in life.
FPIES is a gastrointestinal hypersensitivity to certain foods, with most children being sensitive to more than one type. While milk and soy are the most common culprits, it can occur with nearly any food. Some of the more frequent foods to cause FPIES are poultry, grains and sweet potatoes. Breast milk has not been shown to cause FPIES.
Symptoms can begin anywhere from one to eight hours after the food is ingested, creating a delayed reaction. Stomach ache, nausea, vomiting and diarrhea are all symptoms and can range from very mild to severe. In the mildest form, there will be light vomiting or heaving. The most severe form could see the child fall into shock as a result of dehydration. The child should be taken to an emergency room immediately, if these symptoms occur.
Doctors might not be able to accurately diagnose FPIES at first, because the symptoms are similar to stomach flu and other, more common problems. The reaction does not involve an actual allergic reaction, so there will be no swelling or other abnormalities on the skin. The only way to diagnose FPIES is to observe eating habits, history and other factors. As of 2011, there is no blood test that can detect it.
Treatment for children with severe reactions can immediately include an intravenous (IV) drip to hydrate the body and other injections to treat occurrences of low blood pressure that might result from shock or dehydration. In the long term, the only treatment is a restricted diet that removes most of the foods that have been known to cause the reaction. This diet is usually followed until at least the age of 3, when most children stop having the hypersensitivity to the foods.
Depending on the circumstances, doctors might attempt to determine if the child has outgrown FPIES at a certain age by performing a supervised food challenge. This involves feeding the problematic foods to the child while the child is being observed. If no reaction occurs within a few hours, then it is a sign that the hypersensitivity may have abated.
