FPIES and FPIP

Simple Food Protein Induced Enterocolitis Syndrome (𝐅𝐏𝐈𝐄𝐒) or Food Protein Induced Proctocolitis (𝐅𝐏𝐈𝐏) is often mistaken for a viral infection causing vomiting and diarrhoea, with occasional blood in stool.⁣

Often, and not wrongly, it may be diagnosed as a 𝘯𝘰𝘯-𝘐𝘨𝘌 𝘢𝘭𝘭𝘦𝘳𝘨𝘺, with the most common being CMPA.

• This is because it normally tends to have mild symptoms.⁣
  

Important to note that severe 𝐅𝐏𝐈𝐄𝐒 is relatively rare and less common than Anaphylaxis!⁣
















𝐅𝐏𝐈𝐄𝐒 most common triggers:⁣

1. Milk⁣
   
2. Soy⁣
   
3. Rice⁣
   
4. But can be associated with a long list of food proteins⁣
   

Most children will be able to tolerate the food causing the reaction by the age of 2 or 3 years old.⁣ In some cases, it may persist throughout life.⁣

Children with recurrent episodes may suffer from poor growth and weight loss - failure to thrive.⁣

Usually children will recover very fast from an episode of 𝐅𝐏𝐈𝐄𝐒, as long as appropriate diagnosis and treatment is made.⁣

For severe cases, the best treatment is fluid resuscitation.⁣

• What does not work to treat them:⁣
  

1. Adrenaline auto-injector⁣
   
2. Antihistamines⁣
   
3. Steroids⁣
   
4. Antibiotics⁣
   

Though you will often see all of them being used due to the worry it is either Anaphylaxis or Sepsis.⁣

In the case of 𝐅𝐏𝐈𝐏, most symptoms tend to resolve by 6 months of age (50%) or 9 months of age (95%).⁣

The advice is to reintroduce the causing food into the mother's diet after an exclusion period of 6 months or give it to the child when reaching 12 months of age.⁣

For both cases, if the child is formula fed be aware that:⁣

1. Medical and dietetic advice needs to be sought before a restriction diet is done⁣
   
2. It might take 2 weeks for improvement to be seen⁣
   
3. The child will need and Extensively Hydrolysed Formula (EHF - first choice) or eventually an Amino Acid Formula (AAF - second choice)⁣
   

In the case of a breastfeeding mother, a restriction diet needs to be guided by a dietitian.⁣

• This is to be sure appropriate nutrition (focusing on protein and calcium) is achieved.⁣
  

For 𝐅𝐏𝐈𝐄𝐒, there seems to be a 30% chance of people involved to develop either 𝘢𝘵𝘰𝘱𝘪𝘤 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴 (eczema), 𝘢𝘴𝘵𝘩𝘮𝘢 or 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 (allergic rhinitis).

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