FPIES: The 'Other' Food Allergy

Anna Nowak-Wegrzyn, MD


April 03, 2013

Does FPIES Resolve?

There has been wide variance in reports of FPIES resolution from different countries, which may reflect differences in the population studied (general vs referral) and the frequency of coexisting atopic diseases. In most studies, FPIES to milk and soy resolves by 3 years of age.[2,3,7,8]

Studies of solid-food FPIES in the United States have reported resolution by age 3 years that varied for different foods. Resolution occurred in 67% of cases of FPIES induced by vegetables, 66% of those related to oat, and 40% of children with solid-food FPIES caused by rice. These results are likely confounded by the fact that vegetables, rice, and oat are not essential to the diet and easy to avoid. Many parents may therefore elect to defer follow-up for OFCs to these grains for their children. The majority of children with FPIES have negative skin-prick testing and undetectable serum food-specific IgE at diagnosis. Sicherer[6] observed that children with detectable food-specific IgE tend to have a more protracted course and are at risk of developing IgE-mediated immediate-type symptoms. Therefore, including skin-prick testing and/or measurement of serum food-specific IgE levels in the initial as well as follow-up evaluations is prudent to determine timing and type of OFCs needed.

Long-term Management

Emma is now 3 years old. She has successfully incorporated a variety of foods into her diet. However, her parents have continued to strictly avoid milk because she had a reaction to cheese in jarred baby food at 9 months of age that caused several episodes of emesis and lethargy and required IV rehydration. The most recent reaction occurred to milk in a chocolate cake at the age of 2 years. Within 2 hours, she vomited 3 times but recovered at home with oral rehydration.