What Is Food Protein-Induced Enterocolitis Syndrome (FPIES)?

  • Maha AhmedMBBS, Intarnal Medicine and General Surgery, Cairo University, Egypt

Have you ever heard of food protein-induced enterocolitis syndrome (FPIES)? It's a rare but serious gastrointestinal disorder that can cause severe vomiting, diarrhoea, and dehydration in children and adults. But what exactly is FPIES, and how does it impact your health? Read on to learn more!

Key takeaways:

  • FPIES is a rare but serious food allergy that affects the gastrointestinal tract.
  • This condition is most common in infants and young children, but it can also occur in adults.
  • It is caused by a delayed immune system response to certain food proteins.
  • Symptoms of FPIES can include vomiting, diarrhoea, dehydration, and lethargy.
  • There is no cure for FPIES, but it can be managed with dietary restrictions.
  • The most common trigger foods for FPIES are cow's milk, soy, wheat, rice, and oats.
  • People with FPIES need to avoid these foods and any products that contain them.
  • It is important to work with a healthcare professional to develop a personalised plan for managing FPIES.
  • With careful management, people with FPIES can live full and active lives.

What is food protein-induced enterocolitis syndrome?

FPIES is a non-IgE-mediated food allergy,1 which means that it's not caused by the same antibodies that trigger other food allergies. Instead, it's thought to be caused by a delayed immune system response to certain food proteins.

When someone with FPIES eats a trigger food, their immune system releases chemicals that cause inflammation in the small intestine. This inflammation can lead to vomiting, diarrhoea, and other symptoms.

FPIES can be a very challenging condition to manage, as there is no cure. If you think your child or you may have FPIES, it's important to see a doctor for diagnosis and treatment. With careful management, people with FPIES can live full and active lives.

Symptoms and diagnosis of FPIES

Let's take a look at the common symptoms2 of this rare medical condition that occurs in 1 out of every 300 children3 and how it is diagnosed:


  • Vomiting: This is one of the most prominent symptoms of FPIES. Children may experience frequent episodes of vomiting, usually within a few hours after consuming the trigger food.
  • Diarrhoea: FPIES can cause watery and often explosive diarrhoea, which may persist for several days.
  • Dehydration: Due to vomiting and diarrhoea, children with FPIES can quickly become dehydrated. Signs of dehydration include dry mouth, decreased urine output, and lethargy.
  • Delayed Reaction: Unlike other food allergies that typically cause immediate symptoms like hives or difficulty breathing, FPIES reactions tend to have a delayed onset. Symptoms may appear 2-6 hours after ingesting the trigger food.


  • Medical History: Your healthcare provider will start by gathering a detailed medical history of your child's symptoms, including information about their diet and any suspected trigger foods.
  • Elimination Diet: This involves removing suspected trigger foods from your child's diet to see if their symptoms improve. If there is a clear improvement, it suggests a possible food allergy.
  • Oral Food Challenge Test: This is considered the gold standard for diagnosing FPIES. Under medical supervision, your child will be given small amounts of the suspected trigger food to see if it elicits an allergic reaction.
  • Allergy Testing: While skin prick tests and blood tests (specific IgE) are not typically helpful in diagnosing FPIES, they may be used to rule out other types of allergies.

It's important to consult with a healthcare professional if you suspect your child may have FPIES, as they can provide an accurate diagnosis and guide you in managing their condition.

Common triggers for FPIES and foods to avoid

Parents and caregivers need to be aware of common triggers for FPIES and the foods to avoid to manage this condition effectively. Here are some common triggers and foods to be cautious with:

Cow's milk protein

Dairy products, including cow's milk, cheese, yoghurt, and butter, can trigger FPIES reactions in some individuals. It is important to carefully read food labels and avoid any products containing cow's milk protein.

Soy protein

Soy-based products such as tofu, soy milk, soy sauce, and soy-based infant formulas can also be potential triggers for FPIES. Checking ingredient lists for soy protein is crucial when selecting foods.

Grains and cereals

Certain grains and cereals like rice, oats, barley, and wheat have been identified as triggers for FPIES reactions in some cases. It is advisable to consult with a healthcare professional to determine which specific grains should be avoided.

Poultry and fish proteins

Chicken, turkey, and fish can also be common triggers for FPIES reactions. It is essential to be cautious while introducing these proteins into the diet of an individual with FPIES.

It's important to note that FPIES triggers can vary from person to person.4 Therefore, it is recommended to work closely with a healthcare professional or registered dietitian who specialises in food allergies to develop a personalised plan for managing FPIES.

5 Steps to managing FPIES: dietary restrictions and treatment options

Managing FPIES (Food Protein-Induced Enterocolitis Syndrome) involves a combination of dietary restrictions and treatment options. Here are the steps to effectively manage FPIES:

Step 1: Identify food triggers

The first step is to identify the specific food triggers that cause an allergic reaction in the individual with FPIES. This is typically done through a process of elimination, where potential trigger foods are removed from the diet and then reintroduced under medical supervision to observe any adverse reactions.

Step 2: Implement dietary restrictions

Once the trigger foods are identified, it is essential to strictly avoid them in the individual's diet. This means carefully reading food labels to check for any potential allergens or cross-contamination. It may also be necessary to eliminate certain food groups, depending on the individual's specific triggers.

Step 3: Hypoallergenic formulas

In cases where breastfeeding is not possible or when additional nutrition is needed, hypoallergenic formulas can be used as an alternative. These formulas are specially designed to be less likely to trigger an allergic reaction in individuals with FPIES.

Step 4: Introduction of new foods cautiously

As part of managing FPIES, new foods should be introduced cautiously and under medical supervision. This is typically done through a process called food trials, where one new food is introduced at a time in small amounts. The individual's reaction is closely monitored to identify any potential triggers.

Step 5: Regular follow-up with healthcare professionals

Regular follow-up visits with healthcare professionals, such as allergists or paediatricians, are crucial for monitoring the individual's progress and making adjustments to their management plan if necessary. These professionals can guide diet modifications and help ensure that the individual's nutritional needs are being met.

Remember, managing FPIES requires careful attention to dietary restrictions, as well as close collaboration with healthcare professionals who specialise in allergies and immunology. By following these steps, individuals with FPIES can better manage their condition and lead a healthier life.

9 Practical tips for parents of children with FPIES: coping strategies and support networks

When it comes to parenting a child with FPIES (Food Protein-Induced Enterocolitis Syndrome), having practical coping strategies and access to support networks is crucial. In this section, we will discuss some valuable tips for parents who are navigating the challenges of raising a child with FPIES.

Tip 1: Join FPIES support groups

Connecting with other parents who have children with FPIES can provide invaluable support and understanding. Online forums, social media groups, and local support networks can help you find a community that understands your unique challenges.

Tip 2: Work with healthcare professionals

Build a strong relationship with your child's healthcare team, including doctors, dietitians, and specialists. Regular check-ups and consultations can help ensure your child's health and provide guidance on managing FPIES symptoms effectively.

Tip 3: Educate caregivers and family members

It's important to educate those who regularly care for your child about FPIES. Share information about the condition, symptoms to watch out for, and emergency protocols. This will help ensure that everyone is well-prepared to respond appropriately in case of an FPIES reaction.

Tip 4: Create a safe food environment

Implementing strict avoidance of trigger foods is essential in managing FPIES. Develop strategies to prevent cross-contamination by thoroughly cleaning cooking utensils, plates, and surfaces. Label food containers clearly and communicate clearly with caregivers and family members about safe food choices.

Tip 5: Keep a food diary

Maintaining a detailed record of your child's diet and any symptoms they experience can help identify trigger foods more easily. Note down everything your child consumes, including specific ingredients and brands, as well as any reactions they may have.

Tip 6: Advocate for your child

Be proactive in advocating for your child's needs in various settings, such as schools or daycare centres. Work closely with teachers, administrators, and staff to ensure that they are aware of your child's dietary restrictions and understand how to handle potential reactions.

Tip 7: Plan for emergencies

Create an emergency plan with clear instructions on how to respond in the event of an FPIES reaction. Share this plan with caregivers, family members, and anyone who regularly looks after your child.

Tip 8: Stay informed about research and treatments

Keep up to date with the latest research and treatment options for FPIES. This knowledge can help you make informed decisions about your child's care and explore potential new therapies or interventions.

Tip 9: Take care of yourself

Caring for a child with FPIES can be challenging, so it's important to prioritise your well-being. Seek support from friends, family, and support groups. Consider joining parent self-care activities or seeking professional help if needed.

Remember, always consult with healthcare professionals for personalised advice and guidance tailored to your child's specific needs.

Outgrowing FPIES: is it possible? potential for outgrowing FPIES with age or medical intervention

When it comes to outgrowing FPIES, the good news is that many children do tend to outgrow it with time. However, the timeline for outgrowing FPIES varies from child to child. Some may outgrow it by the age of 3 or 4, while others may take longer.

Medical intervention can also play a role in managing and potentially speeding up the process of outgrowing FPIES. Working closely with a healthcare professional, such as an allergist or gastroenterologist, can help in developing an appropriate treatment plan.

It's important to note that every case of FPIES is unique, and there is no guaranteed way to predict if or when a child will outgrow it. Regular follow-ups with healthcare professionals are essential for monitoring the child's progress and adjusting their treatment plan accordingly.


Food protein-induced enterocolitis syndrome (FPIES) is a rare but serious gastrointestinal disorder that can cause severe vomiting, diarrhoea, and dehydration in children and adults. It is caused by a delayed immune system response to certain food proteins. There is no cure for FPIES, but it can be managed with dietary restrictions and close monitoring by healthcare professionals.


  1. Food protein-induced enterocolitis syndrome (Fpies) | aaaai [Internet]. [cited 11 August 2023]. Available on: https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/food-protein-induced-enterocolitis-syndrome-fpies#:~:text=FPIES%20allergic%20reactions%20are%20delayed,system%20rather%20than%20IgE%20antibodies.
  2. Philadelphia TCH of. Food protein-induced enterocolitis syndrome(Fpies) [Internet]. 2014 [cited 11 August 2023]. Available on: https://www.chop.edu/conditions-diseases/food-protein-induced-entercolitis-syndrome-flies 
  3. Fpies [Internet]. North West Allergy Network. 2023 [cited 11 August 2023]. Available on sur: https://allergynorthwest.nhs.uk/home-patient/managing-allergies/patient-leaflets/fpies/
  4. FPIES UK [Internet]. [cited 11 August 2023]. Information. Available on: https://www.fpiesuk.org/whatisfpies
  5. Food protein-induced enterocolitis syndrome - symptoms, causes, treatment | Nord  [Internet]. [cited 11 August 2023]. Available on: https://rarediseases.org/rare-diseases/food-protein-induced-enterocolitis-syndrome/
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Linda Eva Seuna Kamaha

Bachelor of Science in Biochemistry, University of Yaounde
Master of Professional in Applied Nutrition, University of Ngaoundere, Cameroon

Linda is a clinical nutritionist and SEO health content marketer/writer with several years of experience. She loves demystifying complex health concepts and debunking myths to help people become more health-savvy. When she's not busy copywriting, blogging, or creating topic clusters, you'll probably catch her enjoying a delicious bowl of pineapple slices or embarking on a nature hike with her family.

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