Fpies

Overview

FPIES is a rare food allergy that affects the gut, also called the digestive system. It causes repeated vomiting and diarrhea a few hours after a person eats a certain food. It is not the same as a typical food allergy that causes hives or breathing problems, although severe reactions can still be serious. FPIES can be scary, but it can be managed with help from a healthcare team.

FPIES is rare. It is uncommon even among children who have other food allergies.

Most cases are diagnosed in babies and young children, often in the first year of life. It can affect adults too, but this is much less common.

Symptoms

Common symptoms

• Repeated vomiting, often starting 1 to 4 hours after eating the trigger food
• Diarrhea, sometimes with mucus or blood
• Pale skin or lips
• Feeling very tired, floppy, or less responsive
• Signs of low blood pressure in severe cases, such as cold and clammy skin

Symptoms in children

• Repeated vomiting after a feed or meal
• Diarrhea
• Poor feeding or refusing food
• Lethargy, meaning being very sleepy or hard to wake
• Pale or gray color
• Signs of dehydration, such as fewer wet nappies or sunken eyes

Symptoms in older adults

• FPIES is much less common in adults and may be diagnosed later.
• Adults can have repeated vomiting and diarrhea after eating a trigger food.
• They may feel very tired, pale, or light-headed during a reaction.
• Because it is rare in adults, it can be mistaken for infection or other gut problems.

Causes

Main causes

• FPIES is caused by an immune reaction in the gut to proteins in certain foods.
• Common trigger foods include cow's milk, soy, rice, and oats. Other foods such as egg, wheat, or some fruits and vegetables can also trigger it.
• It is not caused by the immediate type of allergy that shows up on standard skin or blood allergy tests, so those tests are often negative.

Risk factors

• Having a family history of allergies, asthma, or eczema
• Having eczema or other food allergies
• Being a baby or young child, especially in the first year of life
• Starting solid foods, when new foods are introduced

When to see a doctor

See a doctor urgently if:

• Your child has repeated vomiting or diarrhea after eating a food.
• Your child shows signs of dehydration, such as fewer wet nappies, sunken eyes, or unusual sleepiness.
• There is blood in the stool or vomit.
• Your child is not feeding or drinking well.
• You are worried about a severe reaction.

Book a routine appointment if:

• You suspect a food is causing repeated vomiting or diarrhea.
• Your child is not gaining weight or is growing more slowly than expected.
• You need help planning a safe diet or understanding food labels.
• You want to know when and how to try a trigger food again.

Diagnosis

Doctors diagnose FPIES mainly by listening to the story of symptoms and looking at the timing of reactions after eating certain foods. There is no single test that proves FPIES. A specialist will often use a food diary, an elimination diet, and a carefully supervised food challenge to confirm the diagnosis.

Tests that may be done

• A detailed food and symptom diary
• An elimination diet, where the suspected trigger food is removed for a time
• A supervised oral food challenge, where the food is given in a safe medical setting to see if it causes a reaction
• Allergy skin prick tests or blood tests for IgE antibodies, which are often negative in FPIES but can help rule out other allergies
• Stool tests to check for infection or other causes of diarrhea
• Growth and nutrition checks

What to expect at your appointment

You may be asked to keep a record of foods and symptoms. A specialist, often an allergist or a gut doctor, will help plan a safe diet. Food challenges are usually done in a clinic or hospital where staff can treat a reaction quickly. This process can take time, so be patient with yourself and your child.

Treatment

The main treatment for FPIES is avoiding the food that triggers reactions. There is no daily medicine that cures FPIES. A healthcare team, including a dietitian, can help make sure the person still gets enough nutrients. For severe reactions, emergency care may be needed.

Self-care at home

• Avoid the trigger food completely and read food labels carefully.
• Keep a written emergency plan and share it with carers, school, and nursery.
• Offer plenty of fluids during and after mild reactions, as advised by your healthcare team.
• Keep a food and symptom diary to help spot patterns.
• Ask your dietitian for safe food swaps so the diet stays balanced.
• Wash hands and clean surfaces well when preparing food for someone with FPIES.

Medical treatments

Doctors do not prescribe daily medicine to prevent FPIES. Treatment focuses on avoiding the trigger food and managing reactions. For severe reactions, emergency care may include fluids given through a vein and medicines given by a healthcare professional. An allergist can guide when to try the food again, often through a supervised food challenge. A dietitian helps plan meals and check growth. Never give medicines for a severe reaction without a clear plan from your healthcare team.

When is surgery considered?

Surgery is not used to treat FPIES. It is managed with food avoidance and specialist allergy care.

Living with this condition

Living with FPIES means being careful about food and having a clear plan for reactions. Many families find it helps to tell teachers, childminders, and family members about the trigger food and what to do if symptoms start. Keep safe snacks and drinks on hand.

Lifestyle tips

• Read ingredient labels every time, as recipes can change.
• Tell school, nursery, and carers about FPIES and the emergency plan.
• Carry any emergency plan or kit your healthcare team has recommended.
• Teach older children to ask about ingredients and to tell an adult if they feel unwell.
• Plan meals and snacks ahead for parties, travel, and eating out.

Diet and exercise

A dietitian can help build a healthy diet around safe foods and suggest alternatives for nutrients like calcium and protein. Children with FPIES should grow and play normally. Exercise is good for overall health, but avoid eating trigger foods before sports or activities.

Mental health and emotional wellbeing

FPIES can be stressful for the whole family. It is normal to feel anxious about feeding, school, and eating out. Some parents feel worried or overwhelmed. Talking to your healthcare team or a counselor can help. If you feel very distressed or have thoughts of harming yourself, contact your doctor or your local emergency number right away.

Prevention

There is no proven way to prevent FPIES. Once it is diagnosed, avoiding the trigger food prevents reactions. Do not remove foods from a baby's diet without medical advice, because early foods are important for growth and development.

Vaccines

There is no vaccine for FPIES. Routine childhood vaccinations are not known to cause FPIES and are recommended according to your local schedule.

Screening programmes

There is no routine screening test for FPIES. Diagnosis is based on symptoms and supervised food trials.

Complications

If left untreated

• Dehydration from repeated vomiting and diarrhea
• Shock, a serious drop in blood pressure, during severe reactions
• Poor growth or weight loss if trigger foods are not identified
• Nutrient deficiencies if the diet is very limited
• Stress and anxiety around feeding and eating

Long-term outlook

Most children with FPIES outgrow it by school age, and some take a little longer. With careful food avoidance, a good healthcare team, and a clear emergency plan, children with FPIES can grow, play, and thrive. Adults with FPIES can also manage it well with specialist support.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.