Food Protein-Induced Enterocolitis Syndrome (FPIES) 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 and begins with repetitive, profuse vomiting. Some infants can become floppy, pale, and cold and develop diarrhoea.

It is important to note that FPIES is not an IgE-mediated allergy; reactions only involve the gastrointestinal system. No hives, welts or swelling occur and an EpiPen® or Anapen® is NOT used to treat this condition.

How can a paediatric dietitian help?

The first reaction can be confronting for parents and caregivers, and avoiding subsequent reactions is the main goal for infants with FPIES. The only option for preventing FPIES reactions is the total avoidance of the triggering food. This is one of the areas where an experienced Paediatric Dietitian can assist. Common foods appear to cause FPIES reactions, such as cow’s milk (dairy), rice, chicken, fish and some types of fruit and vegetables. Whilst 75% of children will only have one food trigger for FPIES, foods with a similar protein structure to the offending food may also need to be avoided. Your child’s Immunologist/Allergist or Dietitian can advise when the time is right to reintroduce these foods. Considering most food triggers provide a range of nutrients in your child’s diet, a Paediatric Dietitian can ensure that your child receives a balanced diet.

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

Aside from a feeding plan, an experienced Paediatric Dietitian can facilitate formula changes if required and assist with developing an effective mealtime environment for your family. An experienced Paediatric Dietitian can find potential exposure sources within your family’s diet and help educate about label-reading to prevent cross-contamination.

Faltering growth can occur with FPIES, especially for children with more than one trigger food or those who also have IgE-mediated allergies. In this case, a Paediatric Dietitian will monitor your child’s development and provide appropriate strategies to ensure your child is growing optimally.

Can I keep breastfeeding if my infant has FPIES?

Most infants tolerate breastmilk from their mother, who consumes a regular, complete diet. Therefore, for most infants with FPIES, breastfeeding is encouraged for as long as the mother and child feel comfortable. In the uncommon occurrence that the infant does react to breastmilk, the mother can choose to continue breastfeeding, or a suitable formula can be recommended. A Paediatric Dietitian can work with the mother to safely exclude the trigger food from her diet and create a balanced maternal diet where required.

Our Paediatric Dietitians at ChildD are highly experienced in working with infants with FPIES.

Further information can be obtained from https://www.allergy.org.au/patients/food-other-adverse-reactions

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