What is food protein-induced enterocolitis syndrome?

Food protein-induced enterocolitis syndrome (often clinically referred to as FPIES) is a non-IgE-mediated digestive tract allergy disease triggered by specific food proteins. It commonly occurs in infants under 6 months old. It is a type of problem that is often misdiagnosed as acute gastroenteritis in pediatric allergy clinics.

A while ago, I met a 5-and-a-half-month-old baby girl who had just started to receive complementary feeding. The mother tried to feed her two mouthfuls of regular formula milk. Within 2 hours, the baby suddenly vomited milk, including all the rice cereal she had eaten before. Later, she vomited yellow-green bile and had diarrhea several times. The elderly in the family thought she had acute gastroenteritis due to a cold stomach, so they brought her for a blood test and found that the inflammation index was still high, so she almost needed antibiotics. After carefully questioning her feeding history and ruling out the possibility of infection and intussusception, it was diagnosed that it was an attack of FPIES.

Don’t think that allergy is just the type of red pimples on the body, redness and swelling around the mouth, and breathlessness. The special thing about FPIES is that its immune response path is different from that of ordinary immediate allergies. It does not cause rash, and the onset is delayed. Severe vomiting usually occurs 1-4 hours after eating the allergenic food. In severe cases, frequent vomiting and diarrhea can lead to dehydration, and the child will be lethargic. It is no wonder that many people’s first reaction is "the stomach is bad."

There is also a trend that is worth noting. Many parents have read relevant content on the Internet. As long as their children vomit after eating, they will turn to FPIES. In fact, the current academic community is very cautious in diagnosing this disease. More common problems such as infection, digestive tract malformation, and surgical acute abdomen must be ruled out first, and then verified through the "avoidance-provocation" test - —That is, the symptoms completely disappear after stopping the suspicious food, and the same reaction occurs again after a small amount of exposure, so that the final diagnosis can be made. If the child is casually labeled as FPIES and blindly avoids more than ten kinds of food, it will easily lead to insufficient nutritional intake and affect growth and development. This is also a point that many specialists have been emphasizing in popular science recently.

Of course, you don’t need to be too anxious if you are diagnosed. Most of the disease is transient. Statistics show that about 80% of children with the disease can naturally tolerate the food they were previously allergic to by about 3 years old, and only a few will continue until school age. As long as you strictly avoid triggering foods on a daily basis, you will not have an attack. Common allergens are actually milk, eggs, soybeans, and wheat. Very few children are allergic to more than three kinds of food, and there is no need to overly restrict foods. If a mild reaction occurs after accidental ingestion, just give some electrolyte water and observe after vomiting. If the symptoms are severe, go to the hospital for prompt treatment, and there will basically be no sequelae of the digestive tract.