MSPI is an acronym for Milk and Soy Protein Intolerance. The symptoms of MSPI can consist of abdominal discomfort, colic, vomiting, loose stools, or visible blood in the stool. However, the presentation of these symptoms is not as severe as that of FPIES. FPIES reactions can be dramatic, with significant fluid loss through vomiting and massive diarrhea, and can result in severe and rapid dehydration.
There can be variability in symptoms and they may not always match the “classical” descriptions. In severe FPIES reactions, shivering, fever or low body temperature were reported infrequently. Some children develop diarrhea with mucous or blood within 6 hours following an FPIES reaction. However, symptoms that start immediately (within minutes) following an ingestion of the food, such as itching, hives, sneezing or coughing suggest an IgE-mediated food allergic reaction, not FPIES. Remember that a child may have FPIES to one food and an IgE-mediated food allergy to other foods, or may develop sudden, IgE type reactions (hives, swelling, etc) to the FPIES trigger food. If you suspect that your child is reacting to a food, you should consult his/her pediatrician for advice and consider an evaluation by an allergist.
Often, allergic reactions, including FPIES do not occur on the first exposure to the offending food. Sometimes the immune system does not “attack” until there are repeated exposures. Nonetheless, there is frequently a reaction on the first “known” exposure, presumably because of some prior small exposures.
It is important to keep your child comfortable and get to medical attention for treatment. If your child has had prior severe FPIES reactions, is vomiting repeatedly, appears ashen-gray or lethargic, call 911 immediately. If you know your child ate their trigger food, you should head off to medical attention, such as an ER rather than a doctors office, so that monitoring and potential treatments can begin promptly. If prior reactions were mild (such as 1-2 episodes of vomiting) and self-limited and your child appears comfortable and is no longer vomiting, oral rehydration with clear fluids or ice chips at home may be sufficient, but always speak with your doctor. Wait 10-15 minutes after an episode of vomiting and start offering small amount e.g. 1 tsp-1tbs of clear liquids every 5 minutes. Do not offer larger volumes of fluid because they may provoke more vomiting.
Symptoms of shock would usually come after significant vomiting and, hopefully, you would have already made your way to an emergency room. Symptoms of shock, when the blood pressure is low, can be difficult to detect because any child with repetitive vomiting already appears ill, However, symptoms of shock could include a pulse that is hard to feel (very fast or very slow), weakness, confusion, listlessness, passing out or having skin color changes such as becoming ashen-gray, pale or blue. You should immediately call 911 to get your child to the emergency care as soon as possible. They will treat with intravenous fluids and potentially additional treatments such as oxygen or steroids. We do not know if giving epinephrine (adrenaline) would help (e.g., an injection via an autoinjector, such as an Epi-pen, at home), but your doctor might prescribe one.
Answers provided collaboratively by Medical Advisory Board members:
Sakina S. Bajowala, MD; J. Andrew Bird, MD; April Clark, RD/LD; John J. Lee, MD; Fred Leickly, MD, MPH; David R. Naimi, DO; Harumi Jyonouchi, MD; Scott H. Sicherer, MD; Anna Nowak-Wegrzyn, MD.
Copyright © 2011, The FPIES Foundation
Page published: June 18, 2012. Last update: Feb.6, 2018. Copyright © 2011,The FPIES Foundation