Food Allergy
Food Protein-Induced Enterocolitis Syndrome (FPIES)
A large portion of the whole GIT
Rare
Exclusively in infants and young children
Rare in exclusively breast-fed infants
Non-IgE mediated allergic reaction
Symptoms of profuse vomiting and sometimes diarrhoea occur 2 to 4 hours after eating food recently introduced in the diet
Children may become pale, floppy, and have reduced body temperature and/or blood pressure during a reaction
Avoidance of trigger food is currently the only effective treatment option, those most children grow out of it in the preschool years (age 3 to 5 years)
Common triggers are rice, cow’s milk and soy, though any food can cause a reaction
Treatment is avoidance
Food Protein Induced Allergic Proctocolitis (FPIAP)
Colon
Benign condition and infant usually appear well
Visible specks of blood, with or without mucus in the stool due to distal colon inflammation
Typically presents between age 2 and 8 weeks
Occurs in breast and formula-fed infants
If the child is thriving, no intervention is required. Occasionally a short elimination of cow’s milk can be considered (maximum of 2 weeks)
Reintroduction is usually successful by age 12 to 18 months
Food Protein-Induced Enteropathy
Small bowel
This occurs mainly in infants
Chronic symptoms e.g. vomiting, diarrhoea, poor growth
May develop anaemia, oedema, and secondary lactose intolerance
Major triggers are cow’s milk and soy
Cow’s milk protein allergy
Criteria for referral to Paediatrics
Food allergy with failure to thrive
Allergic reaction to a food in a child aged 1 year or younger
Multiple food allergies
Suspected severe non-IgE mediated food allergy e.g. FPIES
Food allergy and co-existent allergic disease e.g. eczema and asthma
Eosinophilic Oesophagitis
Infants are irritable, feeding difficulty, poor growth
Reactions within days
Milk, wheat, egg, soy
Treat PPIO trial
Monitoring for Resolution and Reintroduction
Children with CMA should be monitored for the resolution of the allergy since most will outgrow it in childhood.
Extensively heated (baker) cow’s milk - Approximately 70% of children with CMA can tolerate it.
Advancement – The author's personal approach for infants with cow's milk FPIAP is as follows:
Breastfed infants – Mother adds 1 ounce (30 mL) of cow's milk (or dairy equivalent) to her diet and increases her diet by 1 ounce each day for five days.
Formula-fed infants or infants no longer breastfeeding – One ounce (30 mL) of cow's milk (or dairy equivalent) is added to 6 to 8 ounces of the infant's current formula or pumped breast milk and is increased by 1 ounce every two to three days until the infant is drinking a full bottle or cup of milk.
Recurrence – If hematochezia or other symptoms of proctocolitis recur, then we resume the diet restriction for an additional six months before attempting another food reintroduction.