Information — FPIES UK

What age does FPIES typically first present?

FPIES presents usually in early infancy, either with the introduction of cow’s milk formula or when introduction of solids occur.

My Baby is having an acute reaction and vomiting profusely, what should i do?

Seek medical advice immediately. If your baby is lethargic, floppy, pale or blue DIAL 999.

If your child's reaction is less severe or they appear to be recovering it is still best to have your baby checked by a doctor so please contact your GP surgery or 111 for more advice.

It is useful to have a copy of the A&E letter in the emergency plan section or the letter provided by your consultant already printed and in a convenient place such as your babies changing bag, should you ever need to go to hospital.

The doctors at the hospital did blood tests that showed infection, does this mean the illness was not FPIES?

During an FPIES reaction there is a marked increase in white blood cells in the bloodstream, this is also a common sign of infection, so it is very hard to distinguish between the two on blood tests. Babies with FPIES will recover rapidly within a few hours once replacement fluids are given. Antibiotics are not required but some doctors may wish to give them just in case. As sepsis (blood infection) can kill.

What treatment will the doctors at the hospital give?

The treatment is symptomatic. Depending on how ill your baby is, doctors will either give fluids by mouth (if vomiting has stopped) or intravenous fluids. Steroids are sometimes given because the reaction is believed to be due to a T cell response. Adrenalin/ epinephrine is not recommended unless there are also symptoms of an IgE mediated allergy. As stated above the doctor will need to rule out other conditions such as poison ingestion or infection. They may want to give antibiotics if they think the symptoms may be due to infection.

Two recent studies have shown that an anti-sickness drug called Ondansetron, Zofran may help to reduce the severity of reactions, so this may be something your doctor may want to consider.

How many triggers can a child have?

There are many children with only one or two trigger foods which cause FPIES reactions. However Up to 5% of children react to more than 6 or 7 foods. Some children with FPIES will also have IgE mediated and non-IgE mediated allergies to other foods.

For those children who seem to have some degree of symptoms to many other foods, you and your medical team may need to rule out some other causes which are sometimes seen in babies in combination with FPIES, such as non-IgE mediated food allergy or eosinophilic oesophagitis (EOE.)

Will my baby grow out of this condition?

Almost certainly yes, the majority of children outgrow their FPIES reactions by the time they are three years old, with the remainder typically outgrowing them by age 7. There are however some older children and teenagers who still have FPIES. FPIES reactions to fish and shellfish have been reported in adults.

Studies have shown children with positive igE blood/ skin prick tests to their FPIES triggers (this is called Atypical FPIES) take longer to outgrow their problem foods.

How will i know when my child has outgrown it?

For foods that cause FPIES reactions your consultant should arrange a re-trial in hospital, usually 12-24 months after the last reaction. An intravenous cannula may be placed and a skin prick test to the food may be performed (as some FPIES triggers can become IgE allergies over time) before feeding your child the food. Your child will then be observed over the course of the day for any symptoms.

For foods that caused a milder reaction, re-introduction may be done at home following the advice of your consultant or dietitian.