Food Protein-Induced Entero-Colitis Syndrome


Food protein-induced enterocolitis syndrome is also known as FPIES. It is an adverse food reaction involving the immune system. And mainly affects babies and young children. It is caused by an allergic reaction to one or more ingested foods. Resulting in inflammation of the small and large intestine. 

It is typically a non-immunoglobulin E (IgE)-mediated gastrointestinal food allergy. And manifesting as profuse, repetitive vomiting. Often 2-4 hours after ingesting a food. Sometimes with diarrhoea, leading to dehydration and lethargy. Or if it is chronic, watery diarrhoea with intermittent vomiting. Leading to weight loss, failure to thrive, dehydration, and metabolic imbalances.  Some children can become pale, floppy, drop their body temperature, and/or blood pressure during this food-related reaction.

Avoidance of the trigger food protein/s is currently the only effective treatment option. However, most children will outgrow their FPIES in the preschool years.

Common Foods Triggering FPIES

The most common FPIES triggers are rice, cow’s milk (dairy) and soy. Followed by rice, oats, eggs, legumes and meats such as chicken and seafood. However, FPIES rarely occurs in exclusively breastfed infants.

There are no laboratory or skin tests which can confirm a diagnosis of FPIES. This makes diagnosis difficult. The diagnosis is made purely on symptoms.

Management of FPIES

The only treatment is an avoidance of this particular food until the child is older. The typical food allergy treatments and EpiPens do not work with FPIES. Most children outgrow FPIES by three to four years of age. However, this varies between individuals and foods. Only 40-80% of children with FPIES to rice, and 60% to dairy, tolerated these foods by the ages of three to four. The best way to determine if a child has outgrown their FPIES is by a food challenge under medical supervision.

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