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Hot Topic Blog - Feeding, Eating, & Drinking


By Melanie Potock, MA, CCC-SLP, in Colorado, USA

January 2017

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Food Protein-Induced Enterocolitis Syndrome (FPIES) is a condition primarily affecting infants and young children that wreaks havoc on the gastrointestinal tract. According to the FPIES Foundation, “…symptoms include profuse vomiting, diarrhea, and dehydration. These symptoms can lead to severe lethargy, change in body temperature and blood pressure.” Further complications include electrolyte imbalance, shock, and severe medical complications. What may appear to be yet another stomach flu may be a debilitating condition triggered by proteins in certain foods that requires immediate medical intervention.


Here are five facts about FPIES that may surprise you:


-You might be surprised to know that FPIES is a food allergy but cannot be diagnosed via traditional allergy testing. FPIES is not an allergy that is diagnosed via traditional allergy testing, such as skin prick or blood tests (RAST) because FPIES is classified as a non-mediated IgE allergy. There are two types of adverse reactions to dietary proteins - mediated and non-mediated. The difference is in the timing of symptoms. Mediated responses occur almost immediately after consuming the culprit food, and non-mediated refers to a delayed response which may be hours to days later. Although it is possible to still have a positive result on IgE tests to the same food that triggers the FPIES reaction, this type of reaction “may indicate that additional symptoms (hives, anaphylaxis) can occur” according to the FPIES Foundation.


-You might be surprised to know some of the foods containing this type of protein. FPIES symptoms may appear shortly after birth or when solids are introduced. Infants with FPIES often react to the protein in cow’s milk or soy-based formula. Even proteins in breast milk can be a trigger. When solids are introduced, babies commonly react to the protein in rice and oats, which are also traditional first foods in some cultures. Other culprits include barley, poultry, peas, green beans, sweet potatoes, and squash. Even pears have a bit of protein! Every case is unique and requires close monitoring to determine what food or foods trigger the reactions.


-You might be surprised to know that it may not JUST be FPIES. The diagnosis of FPIES is based on a history of symptoms but cannot be diagnosed until other illnesses are ruled out. This may require extensive medical detective work. Per the FPIESFoundation.org, “The most definitive test is a medically supervised oral food challenge (OFC) - where the suspect food is given to the child in a controlled clinical environment. An oral food challenge, however, is not often needed initially if the doctor has excluded alternative illnesses and the medical history is consistent with FPIES.” A variety of medical conditions can be ruled out, but may also be present in addition to FPIES, such as Eosinophilic Esophagitis.  


-You might be surprised to know that some kids grow out of FPIES but not all at once. Many kids slowly outgrow FPIES around age three, but each child is different and it depends on the culprit food. The FPIES Foundation reports, “In one study, 100% of children with FPIES reactions to barley had outgrown and were tolerating barley by age three. However, only 40% of those with FPIES to rice and 60% to dairy tolerated it by the same age.” 


-You might be surprised to know how much you don’t know!  For terrific resources, take a look at FPIES Foundation’s new online learning videos here, including this video from Dr. Nasir, MD, Pediatric Gastroenterologist. Please read more about FPIES at http://www.fpiesfoundation.org/.  For research or medical literature, visit http://fpiesfoundation.org/fpies-medical-literature/.


Melanie Potock, MA, CCC-SLPtreats children birth to teens with difficulty eating. She is the co-author of the award winning Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating (2015) and Baby Self-Feeding: Solid Food Solutions to Create Lifelong Healthy Eating Habits (2016). She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie teaches a variety of live courses about feeding disorders across the country. She can be reached to teach a course or answer your questions at Melanie@mymunchbug.com