Facts about food protein induced enterocolitis syndrome (FPIES)

Facts about food protein induced enterocolitis syndrome (FPIES)

Bailey Koch, RD, CSP, LD

Is a Registered Dietitian, board certified as a Specialist in Pediatric Nutrition. She founded Atlanta Pediatric Nutrition and joined the GI Care for Kids team, providing nutrition counseling to patients and families.

Like other food allergies, FPIES reactions are triggered by eating a particular food or beverage.

Common FPIES triggers:

  • The most common triggers are milk (67%) and soy (41%) followed by grains (19% rice, 16% oat, 10% wheat, 8% corn) and eggs (11%).  
  • 80% react to either milk or soy (or formulas that contain them)
  • 43% of infants with a milk trigger also react to soy.  
  • 42% of babies with a grain trigger react to 2 or more grains.  
  • 24% with milk and soy  react to one or more grains.  
  • Reactions to meat, fruits and vegetables occur but it is less common.  Chicken, turkey, bananas, sweet potato and peas are the most common triggers from these groups.  
  • 70% of those with FPIES react to 1 or 2 foods.  
  • 30% react to 3 or more foods. 
  • 5% react to 6 or more foods.
  • These reactions can happen when these foods pass through breast milk 
  • 20% also have classical (IgE)  sensitivity based on positive skin tests.
picture representing facts about FPIES

When is FPIES outgrown?

  • Milk and soy triggered FPIES is typically outgrown by 18 mo
  • Fish and egg triggered FPIES is typically outgrown by 53 mo
  • Wait 18 mo after the last reaction to try any trigger food again

 This should be supervised or at least directed by an experienced physician

Age of complete FPIES resolution:  

  • 35% by 2 yo 
  • 70% by 3 yo 
  • 80% by 4 yo
  • 85% by 5 yo

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