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FPIES Tips

If your child has recently been diagnosed with FPIES, you may find yourself overwhelmed and confused. Most parents have never heard of FPIES before they are given the diagnosis. You are probably wondering what you should do now. Here is some information to get you started.

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What is FPIES?

Food Protein Induced Enterocolitis Syndrome (FPIES for short) is a rare form of food allergy. The incidence and prevalence is unknown, but in the US it is estimated to be about 0.28% (1). Unlike traditional food allergies, FPIES will not show up on a normal allergy panel. It affects the immune system in a different way. The exact cause of FPIES is still unknown. (Looking for more information on introducing the top 9 allergens? Check out this handbook).

Food allergy written on chalkboard

What are the symptoms of FPIES?

FPIES affects the gastrointestinal system and causes diarrhea and vomiting. What makes it different from other food allergies is that there is a delayed response of 2-6 hours (2). This can make it tricky to figure out food triggers, since there is not an immediate response. If left untreated, the vomiting and diarrhea can lead to dehydration and shock, sometimes requiring hospitalization.

How do you diagnose FPIES?

There is no simple test for diagnosis. Generally diagnosis depends on reported history and symptoms (3). In some cases, doctors may do an oral food challenge in a controlled setting, but often this isn’t necessary. Because FPIES is rare and the symptoms are quite common, often the diagnosis is delayed. Many children are only diagnosed after ending up in the emergency room due to dehydration.

Is there any treatment for FPIES?

The only treatment is strict avoidance of food triggers. If a child ingests an allergen, they may require hydration at a hospital. The good news is that children usually outgrow this allergy.

Common Food Triggers

Please note that any food can be a trigger. Some children will react to 1-2 foods, others may react to many. Every case is very individualized.

  • Milk
  • Soy
  • Rice
  • Oats
  • Other Grains

How to Introduce New Foods

It can be very helpful to keep a food/symptom log as you are introducing new foods, especially since the reactions are delayed. You can continue to offer foods that you know your child tolerates while offering new foods. Continue to avoid any foods that your child hasn’t tolerated (even if they are on the list below). Introduce 1 food at a time every 5-7 days. Monitor for tolerance before adding a new food. Once you know that your child can tolerate that food, you can move onto the next.

Lower Risk Foods:

  • Vegetables: broccoli, cauliflower, parsnip, pumpkin, turnip
  • Fruits: avocado, blueberries, peach, plum, strawberries, watermelon
  • Grains: quinoa cereal, miller (look for iron-fortified when available)
  • Proteins: lamb, tree nut butter and seed butters (sunflower/pumpkin)
  • Fats: avocado oil

Moderate Risk Foods:

  • Vegetables: carrot, chard, green bean, spinach, squash, white potato
  • Fruits: apple, orange, pear
  • Grains: barley cereal, corn cereal, grits, wheat (look for iron-fortified when available)
  • Protein: beef, peanuts and other legumes
  • Fats: canola oil, coconut oil, olive oil

Higher Risk Foods:

  • Vegetables: green pea, sweet potato
  • Fruits: banana
  • Grains: buckwheat, rice, oat (look for iron-fortified when available)
  • Protein: poultry, fish

Just because something is on the higher risk food list doesn’t mean that your child will react to it (just as a food on the lower risk doesn’t necessarily mean it’s safe).

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