What is FPIES?

Children with allergies are increasingly common and because many attend early childhood education and care services, it is an essential legal requirement for early childhood educators to be trained on the full range of allergies most likely to impact children as well as how to prevent and treat reactions if they occur.

There is, however, a new type of life-threatening allergy on the rise among babies and young children, which surprisingly few people know about including doctors. It's called Food Protein-Induced Enterocolitis Syndrome (FPIES) and we've got the low down.

What is FPIES?

FPIES is a dangerous allergic condition involving the immune system where a bad reaction occurs after children eat food. FPIES occurs almost exclusively among babies and very young children and happens when certain new foods are introduced and react with the child's body potentially causing inflammation of the small and large intestine. This inflammation can be life threatening and may result in excessive vomiting, diarrhoea, low body temperature and blood pressure, body shock and even organ failure.

The good news is that most children outgrow FPIES by the time they reach the age of three or four. However, the only way to make sure they no longer have a reaction to trigger foods is to undertake a medically supervised food reintroduction trial.

Why it's not more widely known

The main reason most people, including many medical professionals, don’t know about FPIES is because it's very hard to diagnose. The allergic reaction is delayed and often misdiagnosed as gastro or a bowel obstruction, and skin prick tests and other traditional allergy testing methods don't work. The only way a child can be diagnosed is through repeat allergic episodes which form a pattern and can be tracked back to a specific trigger food.

It's on the rise

Although there's still much to know and learn about FPIES, contrary to previous beliefs, the condition is more common than people think. A study conducted by the Australian Paediatric Surveillance Unit revealed a rate of 15.4 new diagnoses per 100,000 infants each year, concluding that the condition was in fact not rare, and seemingly on the increase.

Key facts to know about FPIES

Not to be confused with the more commonly known type of food allergies caused by Immunoglobulin E (IgE) which can be treated with an EpiPen, FPIES is a non-IgE mediated type of allergy and is much more complicated.

Here are some important facts to be aware of:

• Unlike other food allergies it will not cause hives, swelling, welts or anaphylaxis; and an EpiPen or other forms of administered adrenaline will NOT work.
• The FPIES allergic reaction is delayed and typically results in extreme vomiting 2-4 hours after a trigger food has been eaten, followed by diarrhoea for several days. In severe cases children can become dehydrated and not get enough oxygen, which can cause the body to shut down.
• The most common food triggers are rice, cow's milk and soy; however, any food including chicken, seafood and eggs can create a reaction in certain children. Some children will have more than one trigger food.
• A child with FPIES can also have an IgE mediated food allergy and other allergic conditions such as eczema and asthma.

How to treat FPIES

The best method of treatment for FPIES is simply to avoid the foods that trigger reactions. If an allergic episode does occur, medical treatment will be required which could include IV fluids, corticosteroids and inpatient hospital monitoring. It is therefore imperative that an ambulance is called immediately if an FPIES reaction is suspected in a child, due to the rapid speed in which they can descend into shock.

Tips for early childhood education and care staff

To ensure the safety of children in your care who are diagnosed with FPIES, and any others who may display symptoms or be vulnerable to developing FPIES, the following tips might help.

• Ensure all carers are educated about FPIES and have an action plan in place should an incident occur.
• Have the parents of any diagnosed children supply you with a medical letter outlining the condition that you can supply to ambulance and medical workers in the event of a bad reaction.
• Advise all carers of any diagnosed children's trigger foods and develop a management strategy for ensuring the child doesn't come into contact with them.
• Be extra mindful of any infants starting solids who might be introduced to new foods under your care and look for any warning signs in the hours that follow feeding.

For more information on FPIES visit the Australasian Society of Clinical Immunology and Allergy (ASCIA).