A first-of-its-kind Canadian study is shedding light on an often-confused and underdiagnosed allergy that largely affects infants and young children, often landing them in the emergency room. According to researchers at the Research Institute of the McGill University Health Centre, food protein-induced enterocolitis syndrome, or FPIES, is an immune reaction that causes inflammation of the intestine and can lead to severe fatigue and dehydration within hours of eating certain foods. It generally does not cause hives, swelling, breathing difficulties or anaphylactic shock. The study identified eggs, fish, shellfish, milk and, surprisingly, peanuts as the main triggers of FPIES. Doctor Moshe Ben-Shoshan, the study’s lead author and a pediatric allergist and immunologist at the Montreal Children’s Hospital, said these acute episodes can be extremely distressing for parents and can lead to repeated emergency room visits before children receive a diagnosis. “I think (FPIES) is confusing and challenging in two ways. One is because when it happens, some people tend to think about it as a regular food allergy. They expect to have skin tests. The skin test will be negative because it’s not the same mechanism,” he said in an interview. “The other one is that it can present as other conditions that cause gastrointestinal symptoms. So sometimes you think it’s an infection because it’s not appearing immediately after you eat the food.” If it is not diagnosed correctly, Ben-Shoshan said it will not be managed appropriately, which mainly involves avoiding the trigger food and then reintroducing it under medical supervision. Before this study, Canadian clinicians only had access to data from the U.S. and Europe. Some studies have also suggested the prevalence of FPIES is increasing. Ben-Shoshan said researchers also found that children often outgrow FPIES, particularly when triggered by eggs or milk, after about a year of avoidance. “The interesting thing is, the majority of children were tolerating the same food when it was in a slightly different form. What I mean is processed in a way that is probably rendering it less allergenic,” Ben-Shoshan explained. “For example, cooking. So the majority of kids that reacted to egg were able to tolerate it after a year when it was presented in baked forms like muffins or cookies. Same thing for milk.” He said the next step for the research team will be to study whether trigger foods can be reintroduced earlier. “It will render the lives of families much easier if they can introduce milk or egg much earlier than a year.” The researchers also said they hope to better understand the differences between FPIES in children and adults.
