As a mother, you know that when some young children are allergic to a food like peanuts, they show symptoms almost immediately. Things like hives, difficulty breathing , etc. But this rare allergy we're talking about today called FPIES (Food Protein-Induced Enterocolitis Syndrome) is a little different. What happens here is that the symptoms only start to appear a few hours after the baby eats the food. So many parents think that this is just a normal viral fever or that it's just an upset stomach from eating expired food.
What exactly is FPIES?
Simply put, FPIES is a severe inflammation of the intestines caused by food proteins. It doesn't cause the typical symptoms of a common allergy, such as hives, itching, or swelling. Instead, your baby may experience persistent vomiting and diarrhea.
This condition usually starts when a baby is introduced to formula or solid foods. Most of the time, this condition does not occur with breast milk. However, very rarely, it can occur in breastfed babies. The good news is that most children outgrow this allergy by the time they are 3 or 4 years old .
What are the symptoms of this?
Imagine that you have given your baby a new food. After two or three hours, your baby starts vomiting continuously and uncontrollably. Then, the baby starts to have loose stools. This is the main symptom of FPIES.
Some children may experience these symptoms gradually increasing over time. They may also experience poor weight gain and growth because they are not getting the proper nutrition they need.
In severe cases, excessive vomiting and diarrhea can lead to dehydration and even shock. This is a very dangerous condition.
| Symptoms that may be seen in a severe case (shock) - go to the hospital immediately! | |
|---|---|
| Characteristic | Description |
| Confusion | The child may appear to be disoriented and unaware of what is happening around them. |
| Cold, clammy skin | The body feels unusually cold to the touch, and feels damp as if it is sweating. |
| Excessive thirst | The child needs to drink water all the time. |
| Pale or bluish skin | The skin may change color, become pale, or turn blue around the lips. |
| Breathing changes | Breathing may be rapid or shallow. |
| Lethargy/sleepiness | The child is unusually sleepy, difficult to wake up, and not playing. |
| Weak pulse | The pulse is very weak, almost undetectable. |
If you notice any of these symptoms, take your child to the nearest hospital's Emergency Department (ETU) without delay.
Why is this happening?
This is because some cells in your child's immune system react incorrectly to proteins in certain foods. This response causes a severe reaction in the child's digestive system (gastrointestinal tract), that is, the intestines. But the symptoms of this reaction take between 2 and 8 hours to appear. That's why it's different from other allergies.
Family history shows that between 40% and 80% of children with FPIES have a family history of other allergies, such as hay fever or eczema. Surprisingly, only 20% of children with FPIES have a family history of other food allergies.
What foods most commonly cause FPIES?
This situation is often caused by:
- Cow's milk and dairy products (e.g. yogurt, cheese)
- Soy and soy milk
- Wheat and other grains (e.g. oats, barley)
In addition to these, some children can also develop FPIES from foods that we wouldn't normally think of as causing allergies .
- Barley
- Chicken or turkey meat
- Fish
- Beans
- Oats
- Peas
- Rice
- Pumpkin
- Sweet potato
Don't be alarmed by this list. Not every child will be allergic to all of these. What is allergic to one child may not be to another.
How is the diagnosis made?
If you think your child has FPIES, the best thing to do is to talk to a pediatrician about it. He or she may refer you to a pediatric allergist or a pediatric gastroenterologist.
The doctor will first ask you about your child's symptoms and whether anyone in the family has any allergies. Then, they will run tests to make sure there are no other common causes of vomiting and diarrhea (such as a viral infection).
Sometimes, blood tests and a skin patch test (Atopy Patch Test - APT) can help. An APT involves placing a small metal plate of the suspected food on the child's skin for about 48 hours. However, these tests cannot confirm FPIES 100% of the time.
The only way to confirm whether this is the case is through an Oral Food Challenge (OFC) test. This involves giving the suspected food to the child, little by little, under medical supervision, in a hospital or clinic. This is absolutely forbidden to do at home.
How is it treated?
The treatment is very simple. It involves completely eliminating the food or foods that the child is allergic to from their diet.
- If your baby drinks formula, you should use special formulas that do not contain cow's milk or soy (hypoallergenic formulas). Your doctor will advise you on this.
- Read the label carefully on every food package you buy from the store and check if it contains any allergens.
- Keep a written note from your doctor stating that your child has FPIES with you. It will be very helpful in explaining your child's condition to medical staff in the event of an emergency.
It's normal to feel a little scared and anxious when you learn about this condition. But if managed correctly, your child can be happy and healthy.
Take-Home Message
- FPIES is a rare allergic reaction characterized by vomiting and diarrhea that occurs a few hours after eating a food.
- Symptoms such as rashes and itching, as in normal allergies, are not seen here.
- If the child is unusually lethargic, has a bluish tint to the skin, or is showing signs of confusion, take them to the hospital's Emergency Treatment Unit (ETU) immediately.
- Be sure to seek your doctor's advice for diagnosis and management.
- Most children recover from this condition by the time they are 3-4 years old, so don't panic and be patient.
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