Treatment of Food Protein-Induced Enterocolitis Syndrome in Chronic FPIES with Poor Weight Gain and Failure to Thrive
This protocol addresses the clinical management of chronic food protein-induced enterocolitis syndrome — a persistent presentation marked by continued daily exposure to a triggering food and ongoing gastrointestinal and growth-related consequences.
Clinical Scenario
Chronic FPIES arises when the triggering food is ingested daily, as occurs with formula feeding in infants. The characteristic picture includes intermittent vomiting, chronic diarrhea, and failure to maintain adequate weight gain or frank failure to thrive.
Daily trigger ingestion
Intermittent emesis
Chronic diarrhea
Poor weight gain
Failure to thrive
Treatment Approach
Primary management centres on dietary elimination of the identified trigger food, with caregiver education on avoidance. For infants, feeding decisions depend on the specific clinical situation — including whether breast-feeding can be maintained or whether a hypoallergenic formula is required.
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The full structured protocol specifies which formula types are appropriate, the sequence of clinical steps, and the complete evidence-based regimen for this presentation.
Treatment Goals
- Resolution of vomiting and diarrhea
- Return to usual state of health within 3 to 10 days of initiating appropriate dietary change
- Restored adequate weight gain
References
DOI: 10.1016/j.jaci.2016.12.966
- Occurs with daily ingestion of the food (eg, feeding with CM- or soy-based formula in an infant); symptoms include intermittent emesis, chronic diarrhea, poor weight gain, or FTT.
- Use dietary elimination of the trigger food or foods for the primary management of FPIES and educate caregivers and other care providers regarding avoidance strategies.
- Infants with CM/soy-induced FPIES can be breast-fed or use a hypoallergenic formula, such as casein-based extensively hydrolyzed formula.
- When possible, breast-feeding should be continued, which is consistent with official recommendations for infant feeding.
- Infants with chronic FPIES usually return to their usual state of health within 3 to 10 days of switching to a hypoallergenic formula, although in severe cases temporary bowel rest and intravenous fluids might be necessary.
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