FPIES: The 'Other' Food Allergy

Anna Nowak-Wegrzyn, MD


April 03, 2013

Pharmacologic and Nonpharmacologic Management

As with other food allergy, the cornerstone of therapy is avoidance of the offending food. However, in contrast to IgE-mediated food allergy, the management of acute reactions relies on vigorous rehydration and not on the use of epinephrine and antihistamines. Epinephrine autoinjectors are not routinely recommended for patients with FPIES.

In mild reactions, oral rehydration may be sufficient. However, in more severe reactions, IV hydration is necessary. A single dose of an IV steroid such as methylprednisolone at a dose of 1-2 mg/kg/dose is used, based on the presumed pathophysiology involving T cells. If the reaction is accompanied by severe hypotension, epinephrine and other vasopressors may be required for management.

It is helpful to provide children and their families with an emergency treatment letter that describes the symptoms and management of acute episodes to guide emergency care providers who may not be familiar with FPIES. A template for an emergency letter can be accessed from the International Association for Food Protein Enterocolitis.

Nutritional Management