FPIES

Author: Kathy Beck APD, Paediatric Allergy Dietitian

FPIES, or Food Protein-Induced Enterocolitis Syndrome is a delayed non-IgE-mediated gut reaction to a food, usually presenting in the first 2 years of life. It usually presents as a delayed reaction, occurring 1-4 hours after consuming the food, as repetitive, profuse vomiting. Some infants can become pale and floppy and some develop diarrhoea several hours later. FPIES is not common and affects 1 in 7000 children under the age of 2 years.

Any food can cause FPIES but the most common trigger foods in Australia include rice, cow’s milk, chicken and some fruits and vegetables. Some trigger foods are associated with a higher chance of reaction from other foods. For example, if rice is a trigger, oats are best avoided. The same for cow’s milk, it’s best to avoid soy. Most infants and young children will have only 1 food trigger, but some react to 2 or more foods.

The good news is that most children outgrow FPIES by 3 years of age. A plan for when and how to introduce the trigger food is made by the paediatric immunologist or paediatrician.

Read about FPIES https://www.allergy.org.au/patients/food-other-adverse-reactions/food-protein-induced-enterocolitis-syndrome-fpies

FPIES is diagnosed by a paediatric immunologist or paediatrician and referral to a paediatric dietitian is recommended.

How can a paediatric allergy dietitian help?

A paediatric dietitian experience in food allergy can provide advice about infant feeding to expand the diet whilst avoiding trigger foods. The first reaction can be confronting for parents and caregivers, and there is often anxiety associated with introducing new foods. Working with your dietitian will assist you in providing alternative nutrient dense foods to ensure optimal growth and development.

For example, if cow’s milk is a trigger all dairy needs to be excluded. Dairy foods such as cheese and yoghurt are important contributors for energy, protein and calcium which are necessary for growth and development. The texture of cheese and yoghurt is also important to introduce to infants, so a range of calcium fortified dairy free foods are recommended so the infant will accept a “creamy” texture when they outgrow FPIES. A paediatric dietitian can assist with planning for appropriate alternatives as not all dairy free foods provide appropriate nutrients.

Working with an experienced paediatric dietitian to incorporate variety and introduce other potential allergenic foods to prevent IgE mediated food allergy is recommended.

Without adequate replacement, limiting the variety of foods in your child’s diet can lead to nutritional deficiencies, feeding difficulties, food refusal and poor growth.

About the author

Kathy Beck is a South East Queensland based paediatric dietitian who specialises in food allergy. Kathy is an active member of the Dietitian’s Committee of the Australasian Society of Allergy and Clinical Immunology (ASCIA). Kathy has been a dietitian for over 30 years with the last 15 years working in paediatrics in various clinical settings in Australia and England.