Food protein induced enterocolitis (FPIES)
Food Protein-Induced Enterocolitis Syndrome #FPIES - honoured to be involved with this IFPIES collaboration, check out the new website, a wonderful International resource.
Well done to all IFPIES for achieving this.
Food protein induced enterocolitis syndrome (FPIES) is an under-recognised, and frequently misdiagnosed syndrome. It has been described as a 'weird food allergy'. It is characterised by severe protracted diarrhoea and/or vomiting, and is frequently associated with sepsis-like symptoms, such as pallor and/or lethargy. Symptom onset is usually soon after ingestion of the causal food protein.
Although typically ascribed to cow’s milk and soy, FPIES has also been described after the ingestion of a wide range of food proteins. FPIES is thought to represent a severe cell-mediated, gastrointestinal food hypersensitivity.
The presentation of the syndrome varies from mild (e.g. non-dehydrating vomiting and/or diarrhoea) to severe symptoms. Symptoms may change rapidly and manifest as a state of dehydration. Hypovolaemic shock is present in up to 20% of cases. Understandably, a combination of vomiting, lethargy and resulting acidosis leads to a primary diagnosis of sepsis. In this clinical scenario, the dietary history may not receive prominence, with the result that the syndrome recurs with each subsequent ingestion of the food protein. Failure to recognise the link with diet may lead to multiple intensive or high-care admissions, due to supposed recurrent sepsis. The incidence and prevalence of FPIES is not known.
Common triggers include: Cow's milk, soy and fish. Many other foods have also been linked to the syndrome.
Our clinic has significant experience in the diagnosis and management of FPIES, Prof du Toit has researched and published on the topic.