FPIES – Food Protein-Induced Enterocolitis Syndrome

photo of boy with photos of FPIES triggers below

What is FPIES?

Food protein-induced enterocolitis syndrome, or FPIES, is a severe type of food reaction that affects infants and young children – but it is not similar to food allergies.

FPIES is a non-IgE-mediated reaction to a food protein. Symptoms occur in the gastrointestinal system.

What foods trigger FPIES?

Any food protein is potentially an FPIES trigger, but the most common FPIES reactions are due to:

  • milk
  • soy
  • rice
  • grains

Some children react to just one food, while others react to multiple foods. It’s also possible for some infants to experience reactions to trigger foods via breast milk.

When do FPIES symptoms start?

Unlike most food allergies that produce immediate reactions such as hives, swelling and respiratory symptoms, FPIES reactions are delayed and usually begin about two hours after ingestion of the trigger food.

What are acute FPIES symptoms?

Acute FPIES reactions include:

  • vomiting
  • diarrhea
  • dehydration
  • fatigue.

In about 20 percent of cases, the child will experience a severe reaction leading to shock and a need for emergency intravenous fluids for rehydration. In rarer cases, intravenous steroids may be used to reverse the effects of shock.

What are chronic FPIES symptoms?

Chronic FPIES reactions include vomiting, diarrhea (sometimes with blood or mucus in the stool), weight loss, and in the most severe cases, an inability to gain weight.

How is FPIES diagnosed?

An FPIES diagnosis is made after considering the child’s history of symptoms and exclusion of other conditions, including food allergies. The primary test for FPIES is food trial and error in medically supervised oral food challenges.

Misdiagnosis of FPIES is common. Symptoms might initially suggest a stomach virus.

What is the treatment for FPIES?

There is no cure for FPIES. Strict avoidance of the trigger food is necessary. Parents should work with a dietitian to develop a personalized diet plan that ensures proper nutrition.

A hypoallergenic diet is recommended. It can include an amino acid elemental formula or an extensively hydrolyzed casein or whey formula.

Many children outgrow FPIES between the ages of 1 and 3, although for some it lasts until 6 or 7; for others, it is a lifelong condition.

Patient Resources

FPIES foundation: fpiesfoundation.org
International FPIES association: fpies.org

Patient Stories

Amanda, Nick and Matthew’s Story

I was excited to start my son Matthew on solid foods when he was 6 months old. It started well … until I fed him rice cereal. Two hours later, he was vomiting every few minutes.

A week later, I tried feeding him rice cereal again. Two hours later, more vomiting. I was worried. I knew something was wrong.

So I googled “vomit rice cereal” and discovered a disease with the acronym FPIES that mirrored Matthew’s symptoms. My husband and I took him to see an allergist and the diagnosis was confirmed: food protein-induced enterocolitis syndrome. We learned his food triggers and adjusted his diet to avoid them.

When Matthew turned 3, he underwent his first oral food challenge to determine if he had outgrown one of his triggers: dairy. He passed! Matthew was so excited, too. It was an awesome moment. We are hopeful he will pass challenges to all of his triggers.

Amanda Bofferding
Cedar Park, Texas