Enterocolitis is inflammation of both the small intestine and the large intestine. FPIES is Food Protein-Induced Enterocolitis Syndrome. It is an allergy affecting the gastrointestinal tract. It is referred to as FIES or FPIES. Symptoms of FPIES are diarrhoea, severe dehydration and vomiting. Feverish feeling and drop in blood pressure are also the physical symptoms.
FPIES is a non-IgE immune reaction to a particular food; it is rather cell mediated. The explanation is as follows:
The body's immune system which acts as a self-defence mechanism creates antibodies when they mistakenly recognise the food substance as invaders to harm the body and cause infection. This antibody is IgE – or immunoglobulin E produced to protect the body from infection. This is the source of allergic reactions that show up. IgE reactions come up rapidly and immediately after the food is consumed whereas the cell-mediated reactions show up as delayed sensitivity. Antibodies are not involved in cell mediated allergic reactions like FPIES.
Elimination of the problem food from the diet usually will subside all FPIES symptoms. Cow's milk, rice, oat, barley, green beans, potatoes and soy can bring in FPIES reactions. Symptoms usually involve only the gastrointestinal system – both the small intestine and the large intestine. Other types of allergic reactions are not seen. FPIES reactions always begin with severe projectile vomiting – few hours after consuming the food. They can range from mild to severe with repeated vomiting, and then diarrhoea will set in. This may lead to severe dehydration since the child is not able to retain even water and it may go into shock.
Due to this, body cannot get blood circulation to the vital organs, and the shock reaction sets in- dizziness, fainting, rapid pulse, shallow breathing and confusion can set in.
Rapid dehydration and Anaphylaxis are emergency medical conditions requiring hospitalisation. Administering intravenous fluids is the immediate step taken in the hospital since the child does not retain any oral liquid. Dehydration has to be taken care of in the first instance since the salt level in the body would come down very fast. Mild reactions can be treated at home where the child can keep sipping oral electrolytes.
Because FPIES is a rare but a dangerous condition which is life threatening, it is paramount to get timely and proper treatment.
FPIES, fortunately, is not a lifelong condition. Children outgrow this as their immune system becomes stronger by the time they reach 4-5 years and can tolerate foods.
Test and Diagnosis
An allergist or an immunologist will take a detailed medical history, details of food taken, and the reactions with the timeline.
Prevention is always better in FPIES due to the severity and the life-threatening stage the child can reach. Strictly avoiding the food that is causing the reactions would be advised by the allergist. Treatment includes intravenous fluids to combat with the fluid loss from diarrhoea and vomiting and thus hospitalisation.
To assess if the child has outgrown FPIES, a single type of food is introduced at a time in minuscule quantities and evaluated for reactions. The mother of the child has to work along with the allergist to keep checking, monitoring which food is given, which food is tolerated, which can show up reactions later. Maintaining a diary of all such food, quantities and the corresponding results would be good since the allergist can assess if the child has outgrown the allergic reactions and the immune system has matured to a real extent. Lots of patience is required from both the parents, and with the help of the allergist, the child can become alright and healthy.