FPIES: The 'Other' Food Allergy

Anna Nowak-Wegrzyn, MD


April 03, 2013

Key Messages

  • FPIES is a non-IgE-mediated food allergy that primarily presents in infancy. The most common food triggers are CM and soy formulas, although FPIES can also be caused by solid foods, most commonly rice.

  • FPIES manifests as severe, repetitive vomiting, sometimes with diarrhea, which, in severe cases, may lead to dehydration and lethargy in the acute form or failure to thrive in a chronic form.

  • The diagnosis of FPIES is based upon the history, constellation of typical clinical symptoms with clinical improvement following withdrawal of the suspected causal protein, and exclusion of other etiologies. In the absence of classic symptoms, an OFC may be necessary.

  • The differential diagnosis of FPIES is extensive and includes other allergic food disorders, infectious diseases, intestinal obstruction due to anatomic or functional etiologies, severe gastroesophageal reflux disease, as well as metabolic, neurologic, and cardiac diseases.

  • Initial management consists of elimination of the offending food from the diet and an emergency treatment plan for acute episodes due to accidental exposures, with emphasis on rapid rehydration and a single dose of an IV steroid; there is no evidence for the use of antihistamines or epinephrine.

  • CM and soy FPIES resolve in a majority of patients by age 3 years. However, patients with solid-food FPIES and/or those with detectable food-specific IgE may have a more protracted course. The optimal frequency of oral rechallenges to determine resolution of disease is uncertain; in one approach, these OFCs are repeated about every 18-24 months.