March 20, 2025 | Black & Kletz Allergy
Food protein-induced enterocolitis syndrome (FPIES) is a rare condition that causes gastrointestinal symptoms several hours after consumption of certain foods by an individual who has an intolerance to that food. The prevalence rate in the United States is approximately 0.5%. The most common types of food allergy in children and adults are mediated by an antibody called IgE. Food allergies may result in adverse reactions which in some cases may be very severe and even life-threatening in some that may occur within minutes of ingestion of the offending food. The IgE antibodies are specific to the food that causes the reaction.
However, in individuals with FPIES, the intolerance to the food is not caused by IgE antibodies and the symptoms are usually delayed in onset. It should however be noted that on occasion, FPIES may coexist with IgE mediated classic food allergies.
In infants and children with FPIES, the most common foods that trigger gastrointestinal symptoms are milk, soy, oats, rice, and eggs. For exclusively breastfed infants, FPIES reactions generally only begin when other foods are added to their diet. For bottle-fed infants, FPIES reactions may begin in the first few months of life. The most common trigger in adults with FPIES is seafood, particularly shellfish.
Symptoms:
- Vomiting, typically occurring 1 – 4 hours after ingestion
- Diarrhea
- Blood and mucus in the stools
- Dehydration
- Fatigue
- Changes in blood pressure and body temperature
Diagnosis:
- In most cases, allergy skin prick and/or allergy blood tests will be negative, as this condition is not mediated by the IgE antibody.
- The diagnosis is most often established based on a comprehensive history and physical examination, after excluding other common conditions.
- Blood tests usually reveal the immune system’s response to stress, such as infections.
- Confirmation of the diagnosis often requires an oral challenge with the suspected food under close monitoring in a controlled environment in an attempt to trigger the symptoms.
Treatment:
- Children can rapidly become dehydrated following vomiting and diarrhea which may lead to a shock-like condition. Immediate rehydration intravenously and/or orally can be lifesaving.
- Zofran (ondansetron), an oral medication that controls nausea and vomiting, is sometimes useful in older children and adults.
- Breastfeeding infants, who begin exhibiting FPIES symptoms when solids are introduced into their diets, may need to continue exclusive breastfeeding for several more months.
- Infants who have reacted to dairy and/or soy-based infant formulas often need to be switched to hypoallergenic or elemental formulas.
- Oral corticosteroids may sometimes be prescribed in order to reduce the immune reaction as a short term measure.
- In older children and adults, eliminating one or more foods based on the clinical history and/or oral challenges may be warranted for prolonged periods.
- Foods are gradually reintroduced into the diet, one at a time, based on the results of oral challenges.
Prognosis:
- Many children outgrow FPIES and will be able to tolerate the foods spontaneously by the age of 3.
- Dairy is usually tolerated much earlier than rice and other cereals. Seafood may take several years to outgrow.
- Some children continue to experience FPIES symptoms into adolescence and into adulthood.
- As the underlying pathology is not yet fully understood, no curative treatments are available at this time.
The board certified allergy doctors at Black & Kletz Allergy have 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The allergists at Black & Kletz Allergy are very knowledgeable regarding FPIES as well as food allergies. We diagnose and treat both adult and pediatric patients. In addition, we treat hay fever (i.e. allergic rhinitis), asthma, and patients with medication, skin, and skin allergies. We also diagnose and treat sinus disease, eosinophilic esophagitis, mast cell disorders, and immunological disorders. To schedule an appointment, please call any of our offices or you may alternatively click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 5 decades and we look forward to providing you with all-inclusive state-of the-art allergy care in a welcoming and professional environment.
