Our excellent nutritionist, Bailey Koch, recently gave our group a terrific update on FPIES. Bailey is part of the medical advisory board for THE FPIES Foundation, as is Dr. Benjamin Gold from our group. Here are many of the slides from her lecture.
Link: FPIES foundation action plan sheet:
- Link: FPIES Handout for families
- Link: FPIES Foundation
- Link: FPIES Healthcare Provider Webpage
Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. Open Access: International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139:1111-26.
Related blog posts:
- FPIES Guidelines (2017) -this is a detailed summary, including suggestions for offering weaning foods
- SEED Journal Club: FPIES
- Nutrition4Kids and Nutrition4IBD
From FPIES 2017 Guidelines:
- #4. “Consider specific IgE testing of children with FPIES to their trigger food because comorbid IgE-mediated sensitization to triggers, such as CM [cow’s milk], can infer a greater chance of persistent disease.
- ”#8. Conduct food challenges “in patients with suspected FPIES in medically supervised settings in which access to rapid fluid resuscitation is available and prolonged observation can be provided, if necessary.”
- #14. Do not routinely obtain endoscopic evaluation as part of the evaluation of FPIES.
- #17. Acute FPIES should be considered a medical emergency. “Approximately 15% of patients can have hypovolemic shock.”
- #19. Consider ondansetron treatment as an adjunct (if >6 months of age)
- #21. Do not recommend routine maternal dietary elimination of offending triggers while breast-feeding if the infant is asymptomatic.
- #23. FPIES can occur to multiple foods. “The majority of children (65% to 80%) have FPIES to a single food, most commonly CM.” In one study, 5% to 10% of children reacted to more than 3 foods.
- #26. Use hypoallergenic formula in infants who can no longer breast-feed and are given a diagnosis of FPIES caused by CM. Most will tolerate extensively hydrolyzed formulas; some may require an amino acid based formula
- #29. Reviews natural history. “The age of CM tolerance appears to be around 3 years” but there has been variability in reports. For FPIES due to grains, average age of tolerance is 35 months and other solid foods is 42 months. The average age for soy is 12 months (later in some studies), for rice 4.7 years and 4.0 years for oats. For CM-FPIES with positive SPT response, a much protracted course has been reported, with older age of tolerance (~13.8 years)
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