Chelsea Wicks, MD, pediatrician, Renown Medical Group
Well, I learned about something new last month. One of my mothers brought her 4-month-old daughter to see me with their Internet research findings in hand and the diagnosis they had made for her problems.
Initially, I was skeptical as I always worry about what my patients may be finding online as there is so much information out there – some good, some bad. Fortunately, in this case it was very good. What they discovered was something I had never even heard of but turns out to be exactly what I think this little one has been dealing with.
According to the family, she has been breastfeeding beautifully but her daycare was concerned that mom was not providing them with enough breast milk and suggested they start supplementing with formula. Around the time they began supplementing, she began with intermittent vomiting and diarrhea. She was seen at one point by another physician who suspected she had a viral stomach infection and encouraged to continue with pushing fluids and observation. Over time the family realized that her symptoms had started only after she consumed formula. They decided to plug her symptoms in online and they discovered Food Protein-Induced Enterocolitis Syndrome (FPIES).
FPIES is a rare type of food allergy affecting the gastrointestinal tract. It most commonly presents itself with vomiting, diarrhea and dehydration. It is not a typical IgE-mediated allergic reaction so it does not show up on the commonly used skin tests or blood tests for allergies. Unfortunately, that means diagnosis is based on symptoms or on an oral food challenge done in a physician’s office. It most commonly presents in infancy either due to a reaction to milk-protein formula, soy formula or occasional proteins in the breast milk. It can also present upon introduction to solid foods, most commonly rice and oats in the baby cereals.
There is no treatment for this syndrome but it can be managed by avoiding the trigger. In formula fed babies, they can often be placed on hypoallergenic formula such as Nutramigen or Alimentum as the proteins have already been broken down in these formulas. In the case of my patient, she did not have any problems with breast milk so has done well by simply avoiding the formula all together, as long as mom is able to keep up with production.
During an acute episode of vomiting, a child can go into a shock-like syndrome. Rehydration may be necessary with an IV and the child may need to be observed in the hospital. Often the symptoms can mimic those of sepsis which is an overwhelming bacterial infection. In this case, the children are often given antibiotics unnecessarily. Because this is such a rare condition and is not well known even amongst the medical community, it is recommended that families of children with this diagnosis have a letter or some sort of information to bring with them when seeking medical attention so proper treatment will be provided.
If you think your child may be suffering from symptoms that could be consistent with FPIES, I encourage you to have them evaluated by their doctor as soon as possible. To find a doctor visit renown.org/findadoc.