Has your little one started vomiting or having diarrhea within a few hours of eating a new food? Or is it just a stomach ache? Sometimes this can be more than just a stomach ache. Today we're going to talk about a condition that's a little different, but it's very important to know about. That's called FPIES (Food Protein-Induced Enterocolitis Syndrome) . While the name may sound a bit long, it's simply a reaction in our bodies, especially in the intestines, to the proteins in certain foods.
What is FPIES? Let's understand it simply.
Simply put, FPIES (Food Protein-Induced Enterocolitis Syndrome) is an abnormal response of our body's immune system to certain foods. It mainly affects our digestive system (Gastrointestinal - GI system) . That means symptoms like vomiting and diarrhea are the most common.
Unlike food allergies, FPIES symptoms start to appear a few hours after eating . This is what makes this condition so special. Imagine, you eat breakfast and start to feel sick around noon.
Although FPIES is most common in infants and young children , it can sometimes affect adults , so it's important for everyone to be aware of it.
What foods cause FPIES?
Although any food can cause FPIES, there are a few foods that are most likely to cause the condition. They are:
- Milk: Animal milks like cow's milk and goat's milk.
- Infant formula: Some babies may be allergic to infant formula.
- Soy.
- Oats.
- Rice.
- Egg.
- Seafood: Especially shellfish like crabs, shrimp, and other types of fish.
The main foods that cause FPIES may vary depending on the country and region you live in. In Sri Lanka, cases of FPIES caused by these foods have also been reported. Imagine, you have just started your baby on rice, or you have given him yogurt, and a few hours later, your baby is vomiting continuously and his stomach is upset. Then you should be suspicious about this.
There are two main types of FPIES:
FPIES can be divided into two main types:
1. Acute FPIES:
- In this case, symptoms appear within one to four hours of eating the food in question.
- Vomiting and diarrhea can sometimes be very severe. The baby will continue to vomit, to the point of losing consciousness.
- But the good thing is, these symptoms usually subside completely within 12 to 24 hours after the allergenic food is stopped.
2. Chronic FPIES:
- This condition occurs when the food you are allergic to is eaten continuously and frequently.
- This causes long-term inflammation in the intestines.
- Although the symptoms are not as severe as those of acute FPIES, they can come and go. Your baby may have some symptoms such as diarrhea, loss of appetite, and weight loss.
- It can take three to ten days for these symptoms to go away after you stop giving the allergenic food.
What are the symptoms of FPIES? How do you recognize it?
The main symptoms of FPIES are:
- Diarrhea: Sometimes it can be watery or even have a little blood in it.
- Abdominal pain: Small babies cry, hold their stomachs, and struggle.
- Pallor: The body suddenly turns pale and takes on a bloodless color.
- Lethargy: The baby is just lethargic, not playing, and his eyes seem to be closing.
- Unintended weight loss: This can be seen especially in long-term FPIES.
- Hypothermia: The body becomes cold.
Importantly, in FPIES, these symptoms appear several hours after eating the food in question , usually between 1 and 4 hours. In chronic FPIES, symptoms may come and go.
Imagine your baby drank a bottle of milk in the morning. By noon, he starts vomiting continuously, his stomach is bloated, his body is pale, and he just seems lifeless. If that happens, it's important to suspect FPIES.
Why does FPIES occur? What is the cause?
The main reason for FPIES is that our immune system mistakenly thinks that proteins in certain foods are "harmful" and attacks them. The immune system views these foods as if they were an enemy.
What happens in this is that the immune cells in our digestive system (stomach and intestines) try to get rid of the food they think is "harmful". This causes swelling and inflammation in the stomach and intestines. This is what causes vomiting and diarrhea.
FPIES is a type of reaction called `non-IgE-mediated` . Simply put, it does not involve the `IgE antibodies` that are responsible for many of the allergies we know about (e.g., peanut allergies). Instead, other immune cells are involved. Another important thing is that FPIES does not cause the whole-body inflammation that occurs in some other severe allergies. This means that the severe, life-threatening `anaphylaxis` , which causes difficulty breathing, is less likely to occur (although severe dehydration and shock can lead to other serious conditions).
What complications can occur due to FPIES?
FPIES reactions can sometimes lead to serious, even life-threatening, conditions. The most important of these are:
- Shock: This is a sudden, very low blood pressure. This is very dangerous.
- Dehydration: When vomiting and diarrhea continue, a large amount of water and salts are lost from the body. This can happen very quickly in young children, so you need to be very careful.
How does a doctor diagnose FPIES?
A doctor will suspect FPIES after asking you or your child about their symptoms in detail . Things like what foods you ate, how long ago the symptoms started, and what the symptoms were are very important.
Sometimes the doctor may also do a ``food challenge test.'' This involves giving the child, under medical supervision, a small amount of the suspected food to see if there is a reaction. This is not a good idea to do at home, as a severe reaction requires immediate medical attention.
FPIES can sometimes be difficult to diagnose because its symptoms can be similar to those of other conditions, such as bacterial infections. Therefore, your doctor may order allergy blood tests or allergy skin tests to check for other allergies. However, these tests do not necessarily show that a person with FPIES has an allergy.
What are the treatments for FPIES?
Doctors may use the following to treat acute symptoms caused by FPIES:
- Steroids: These are given to reduce inflammation (swelling) in the intestines.
- Intravenous fluids (IV fluids): Things like saline are given to prevent dehydration or to treat dehydration if it occurs.
- Antiemetics: For example, medications like ``Ondansetron (Zofran®)`` help control vomiting.
All of these treatments are given in a hospital, under medical supervision.
What happens if I or my baby has FPIES?
The good news is that most young children outgrow FPIES by the time they are 3 or 4 years old. This means that they can eat the foods they were previously allergic to later on. However, it is best to talk to a doctor and perhaps do a ``food challenge test'' before re-introducing those foods.
Until then, the most important thing is to identify exactly which foods are causing this and stop feeding them. Severe vomiting and diarrhea can be very dangerous, so keep an eye out for that too.
If adults develop FPIES, the best way to manage it is to identify the foods they are allergic to and avoid them. Sometimes, adults can outgrow FPIES over time. However, in many cases, FPIES that begins in adulthood can last a lifetime.
Can FPIES be prevented?
If you know that you or your child has FPIES, the best way to prevent reactions is to completely avoid giving them the foods they are allergic to.
Keeping a food diary can be very helpful in finding out which foods are causing the problem. This means writing down everything your child eats and when. Then, if symptoms occur, you can look at what they ate before they started. Sometimes, the doctor may also recommend an 'elimination diet' (a diet that involves trying out certain foods) .
If your baby has FPIES, your doctor may recommend the following to help prevent these reactions while still providing your baby with the nutrition they need:
- Using hypoallergenic baby formulas . These are specially formulated to be less allergenic.
- When starting solid foods for your baby, introduce fruits and vegetables first instead of grains (e.g., rice, oats).
- Following an FPIES food introduction ladder . This describes the order and method in which new foods should be introduced to your baby.
What should I do as a person with FPIES?
If you have FPIES – or suspect you do – you will need to keep a careful record of what you eat and drink. This will help you pinpoint which foods are causing your reaction. Once you have identified the cause, you should avoid those foods.
What are the best times to see a doctor?
If you think your baby is having a food reaction, whether it's to formula or cow's milk, be sure to see a doctor. Even a minor reaction can interfere with your baby's ability to get the nutrition they need. In cases of severe reactions, you should seek medical advice immediately.
When do you need to go to an Emergency Treatment Unit (ETU) ?
If you or your child experience any of the following symptoms, go to a hospital emergency room immediately:
- Confusion or altered mental state.
- Peeing very little or not at all.
- Sunken eyes – This is a sign of dehydration.
- Swelling of the face, lips or tongue .
- Trouble breathing or swallowing .
These symptoms indicate that the situation is serious.
Important questions to ask the doctor
It's helpful to ask these questions when you visit your doctor:
- Is this a common food allergy, or FPIES?
- How do you find out which foods cause FPIES?
- How can I avoid these allergenic foods while still getting the proper nutrition I/my child needs?
- What should I do if I/my child has this reaction?
Let's learn a little more about FPIES?
- Age of onset of FPIES: FPIES usually begins in infants around 4 months of age , or when the food to which the allergy is attributed is first introduced. If FPIES develops in adults, it is usually seen after the age of 40 .
- How common is FPIES in adults?: FPIES is much less common in adults than in young children. Approximately one in 450 adults (0.22%) has FPIES. The main food that causes FPIES in adults is shellfish .
- Can exclusively breastfed babies get FPIES?: This is very rare, but yes, it is possible. Sometimes, proteins in foods a breastfeeding mother eats can pass to her baby through breast milk and cause FPIES. However, the research on this is not yet conclusive.
- Is FPIES an autoimmune disease?: No, FPIES is not an `autoimmune disease.` Autoimmune diseases are when our immune system mistakenly attacks our own cells. FPIES is an immune system response to food that enters the digestive tract.
Most importantly - the take-home message
FPIES is a rare, but sometimes serious condition that can make it difficult for your child or you to get the nutrition they need. It can sometimes mimic other illnesses, so it takes some testing and experimentation to figure out which foods are causing it.
Don't worry. A doctor can help you figure out what foods to avoid, and talk to you about ways to stay healthy and get the nutrition you need. If you catch it early and manage it properly, you can stay healthy with this condition. The most important thing is to seek medical advice if you have any concerns.
` FPIES, food allergy, baby vomiting, baby diarrhea, food proteins, enterocolitis syndrome, immune system
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