The International FPIES Association (I-FPIES) is excited to announce the publication of the “International Consensus Guidelines for the Diagnosis and Management of Food Protein-Induced Enterocolitis Syndrome.” An executive summary has been published in The Journal of Allergy and Clinical Immunology (JACI), and the full document is available open access online.
These FPIES guidelines were designed to improve quality and consistency of care for FPIES patients by offering clinicians recommendations for disease diagnosis and management. The guidelines address the following topics: Definition and Clinical Manifestations, Epidemiology, Diagnosis, Gastrointestinal Manifestations, Acute Management, Nutritional Management, Natural History, and Future Needs.
The guidelines are the result of a three-year global collaboration led by the International FPIES Association and included the input of more than forty leading FPIES experts. Anna Nowak-Wegrzyn, MD, and Matt Greenhawt, MD, co-chaired the guidelines committee that led the effort to develop clinical questions about the diagnosis and management of FPIES. After extensive literature review and data extraction, draft recommendations were considered by an international expert panel that reached consensus on thirty recommendations.
I-FPIES Founder and President Fallon Schultz says, “Dozens of FPIES experts from across the globe volunteered their time and efforts to make the I-FPIES guidelines initiative a reality. These first ever, standard of care guidelines for FPIES will fill a significant clinical gap. And beyond that, the guidelines will highlight opportunities for future research, inform health care coverage policy, and lead to needed educational programs.”
The “International Consensus Guidelines for the Diagnosis and Management of Food Protein-Induced Enterocolitis Syndrome” were submitted to and approved by American Academy of Allergy, Asthma, and Immunology (AAAAI) as a Workgroup Report of the Adverse Reactions to Foods Committee.
The International FPIES Association has a global dissemination plan in place for the guidelines that includes outreach to various clinician groups, including allergists, gastroenterologists, pediatricians, ER physicians, allied health professionals, nurses, dietitians, as well as parents and relevant advocacy groups. There will also be a national outreach plan to reach every allergist in the United States.
For international outreach, the I-FPIES medical advisors and executive board will be traveling to major society meetings to educate providers worldwide, and the guidelines will be made available in multiple languages through the organization's partnerships.
To find out more about the FPIES guidelines, visit the I-FPIES website: http://fpies.org/index.php/about-fpies/fpies-guidelines
FPIES is a non-IgE gastrointestinal food allergy that manifests as delayed, profuse vomiting, often with diarrhea, acute dehydration, and lethargy. The most common triggers are milk and soy, but any food, even those thought to be hypoallergenic (e.g., rice and oat), can cause an FPIES reaction. Unlike most food allergies that produce immediate reactions such as swelling and hives, FPIES reactions are delayed and usually begin two hours after ingestion of the trigger food. In some cases, the child will have such an extreme reaction that they go into shock and need to be admitted to the ER for immediate treatment with intravenous fluids.
There is currently no cure or standardized treatment for FPIES. Unlike common food allergies, standard skin testing and blood testing for specific IgE allergies are routinely negative in FPIES patients. Early diagnosis and treatment are important for preventing FPIES reactions; however, reaching a diagnosis is often delayed.