Browsed by
Tag: FPIES

True food allergy or not, baby tummies still hurt

True food allergy or not, baby tummies still hurt

　Uppercase terms for longer names of ailments are very common. The ones mentioned here are the two most common mimics of true food allergy in infants.

Symptoms of FPIES (food protein-induced enterocolitis syndrome) are vomiting/reflux with diarrhea, and of FPIAP (food protein-induced allergic proctocolitis), colic and diarrhea. Blood (either visible or microscopic) in the stool is common with both.

FPIAP tends to occur at younger ages, often in the first two weeks of life, and occurs in infants who are exclusively breast-fed and those receiving formula. FPIES emerges later at around 5-8 months.

The allergic antibody IgE, which is the driving force for traditional food allergy and other allergic conditions, apparently isn’t involved.

The leading cause for both conditions is cow milk protein, accounting for 71% of FPIAP, and 79% of FPIES. The next most common cause is soy. This is especially problematic when the infant is bottle-fed as the next common protein base for infant formula (after cow milk) is soy. Much less common causes include eggs, lentils, grains, fish, meat and nuts.

Diagnosis confirmation can be obtained in a clinical setting by doing an oral food challenge where the suspected food is purposefully given after a period of avoidance, and then observing for the symptoms.

For a mother who is exclusively breastfeeding her baby, removing the food from the mother’s diet cures the problem.

Some good news is that more than 90% of children outgrow these problems by age 2. Unfortunately, about 20% of these afflicted children will go on to develop traditional food allergies.

 

OJ now known to cause FPIES

OJ now known to cause FPIES

Food protein-induced enterocolitis syndrome (FPIES) has recently been reported to occur from orange juice, a previously unrecognized cause.  FPIES mimics food allergy, but it is not mediated by IgE (Immunoglobulin E), the usual allergic mechanism. It is an acute inflammation of the GI tract, caused by a food protein that leads to nausea, vomiting and diarrhea.  Frequently, affected children become dehydrated and require IV fluids.  The condition is often mistaken for a GI flu until the causal association with a food protein is recognized.  The most common cause for FPIES is cow milk. The diarrhea seen with cow milk ingestion is often bloody and, hence, quite startling to unsuspecting parents of infants who develop FPIES.
Other well-recognized causes: rice and soy protein.  The newly described cause is fruits (including apple, pear and banana) and most recently, orange juice.  Unlike with food allergy, children with FPIES have no rash, angioedema or respiratory symptoms. Also, the reaction (unlike with food allergy which tends to be immediate) is generally delayed two-to-four hours after ingestion of the trigger food. Because FPIES is not a classic allergic condition, it cannot be diagnosed by allergy testing.  The best method for diagnosis is recognizing the suspected food as an antecedent to the symptoms. Also, oral food challenge tests can be conducted to confirm the diagnosis.