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            FPIES and FPIP

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            FPIES and FPIP

            Published by Dr Josรฉ Costa at 20/02/2021

            Simple Food Protein Induced Enterocolitis Syndrome (๐…๐๐ˆ๐„๐’) or Food Protein Induced Proctocolitis (๐…๐๐ˆ๐) is often mistaken for a viral infection causing vomiting and diarrhoea, with occasional blood in stool.โฃ

            Often, and not wrongly, it may be diagnosed as a ๐˜ฏ๐˜ฐ๐˜ฏ-๐˜๐˜จ๐˜Œ ๐˜ข๐˜ญ๐˜ญ๐˜ฆ๐˜ณ๐˜จ๐˜บ, with the most common being CMPA.

            • This is because it normally tends to have mild symptoms.โฃ

            Important to note that severe ๐…๐๐ˆ๐„๐’ is relatively rare and less common than Anaphylaxis!โฃ

            ๐…๐๐ˆ๐„๐’ most common triggers:โฃ

            1. Milkโฃ
            2. Soyโฃ
            3. Riceโฃ
            4. But can be associated with a long list of food proteinsโฃ

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

            Children with recurrent episodes may suffer from poor growth and weight loss – failure to thrive.โฃ

            Usually children will recover very fast from an episode of ๐…๐๐ˆ๐„๐’, as long as appropriate diagnosis and treatment is made.โฃ

            For severe cases, the best treatment is fluid resuscitation.โฃ

            • What does not work to treat them:โฃ
            1. Adrenaline auto-injectorโฃ
            2. Antihistaminesโฃ
            3. Steroidsโฃ
            4. Antibioticsโฃ

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

            In the case of ๐…๐๐ˆ๐, most symptoms tend to resolve by 6 months of age (50%) or 9 months of age (95%).โฃ

            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.โฃ

            For both cases, if the child is formula fed be aware that:โฃ

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

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

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

            For ๐…๐๐ˆ๐„๐’, there seems to be a 30% chance of people involved to develop either ๐˜ข๐˜ต๐˜ฐ๐˜ฑ๐˜ช๐˜ค ๐˜ฅ๐˜ฆ๐˜ณ๐˜ฎ๐˜ข๐˜ต๐˜ช๐˜ต๐˜ช๐˜ด (eczema), ๐˜ข๐˜ด๐˜ต๐˜ฉ๐˜ฎ๐˜ข or ๐˜ฉ๐˜ข๐˜บ๐˜ง๐˜ฆ๐˜ท๐˜ฆ๐˜ณ (allergic rhinitis).

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