FPIES is the food allergy you've never heard of
Australian immunologists are seeking to boost awareness of food protein-induced enterocolitis syndrome (FPIES) — an allergic reaction in the stomach that is often misdiagnosed due to our limited knowledge about it.
Mostly impacting children under two years of age, FPIES typically presents 1–4 hours after ingestion of the trigger food, with symptoms including profuse vomiting, pallor and lethargy. Other features can include hypotension, hypothermia, diarrhoea, neutrophilia and thrombocytosis.
Dr Sam Mehr, a paediatric immunologist and allergist at The Royal Melbourne Hospital, and Professor Dianne Campbell, Chair of Paediatric Allergy and Clinical Immunology at the University of Sydney and The Children’s Hospital at Westmead, contributed a narrative review to The Medical Journal of Australia in order to raise awareness of what they describe as a “poorly understood food allergy”.
“Diagnosis is often hampered by the lack of awareness of FPIES, absence of reliable biomarkers, the non-specific nature of the presenting symptoms, and the delay between allergen exposure and symptoms,” they wrote. Indeed, the allergy is often misdiagnosed in infants as sepsis or gastroenteritis.
No blood test exists for FPIES and the treatment in an acute setting is fluid replacement, with ondansetron also believed to be effective. Long-term management involves confirming diagnosis via a food challenge, as well as avoidance of identified trigger foods. In Australia, the most common food triggers for FPIES are, in descending order: rice, cow’s milk, egg, oats and chicken.
The study authors believe that improved understanding of the immunological basis of FPIES will, in the future, facilitate the development of a sensitive and specific biomarker. Until then, recognition and education are key to avoiding an immune response in potential sufferers.
“Use of standardised diagnostic criteria, improved recognition, timely fluid resuscitation, avoidance of trigger foods and education form current best practice,” the authors wrote.
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