For many parents, an FPIES diagnosis is received with a sense of relief; finally, there is a word to describe the source of all the fear and confusion. But with the word FPIES also comes a flood of questions, many pertaining to diet. What foods do I start with? How do I trial foods safely? Who can help to figure it out?
These and other questions are addressed in The First Nutritional Guidelines for FPIES developed by IAFFPE’s Advisory Dietitians Marion Groetch, MS, RD, CDN; Carina Venter, PhD, RD; and Brittany Hofmeister, RD. This piece discusses breastmilk and formula, feeding and developmental needs, what solids to trial, and offers helpful feeding tips and ideas for introducing different textures.
We also interviewed Dr. Carina Venter on this subject for our latest FoodPrints newsletter. She is currently a Senior Research Fellow at the University of Portsmouth, where she is doing a Post Doc in the area of Food Hypersensitivity (FHS). She also works as a Senior Dietitian at The David Hide Asthma and Allergy Research Centre where she sees adult and pediatric patients and takes part in research.
What led you to your interest and specialization in FPIES?
I am based in a primary care, secondary care centre. We see FPIES cases at first presentation, refer them for diagnosis to tertiary care centres and look after them jointly with the specialist centre. I think what fuelled my particular interest in FPIES more than 10 years ago now was the lack of information on how to look after the nutritional intake of these children and which foods they can tolerate.
What developments are you excited to see come from IAFFPE?
It is great to see the interest of other medical professionals in the field. The information in the FoodPrints newsletter is also very exciting – I particularly enjoyed reading the cases presented by Dr Scott Sicherer in the Spring 2012 edition as not many people had the opportunity to attend his session at AAAAI 2012.
What changes are you passionate about for FPIES patients?
As I am based in the UK, my passion lies in educating primary care-based healthcare professionals such as GPs, Dietitians, Health Visitors and Nurses to become aware of FPIES and the fact that it often presents with the introduction of so-called low allergenic foods such as rice and oats.
How can seeing a dietitian help assist an FPIES patient?
Dietitians play a very important role in choosing the most appropriate formula for the child, monitoring their growth, ensuring adequate nutritional intake and helping these children reach their food texture milestones.
What are the most commonly introduced safe foods for a child with FPIES?
As we mentioned in the nutritional guidelines piece [Fall 2012 FoodPrints], children with cow’s milk or soy FPIES have a greater chance of developing FPIES to other foods, particularly grains. We therefore often recommend the introduction of yellow fruits and vegetables before introducing grains. Tolerating one food from a food group, often indicates that other foods from the same group will be tolerated safely (i.e., if oats are tolerated than other grains such as barley and wheat are likely to be tolerated, in most cases).
What creative tips can you offer for a patient with a limited diet and few safe foods?
I think the most important tip I can give is to ask for a referral to a dietitian with an interest in FPIES – or even just a dietitian with an understanding of feeding difficulties. Parents are often surprised about the fact that a healthy diet, with a variety of textures, can be provided based on a very limited number of foods!
Nutritionally, what should a parent of an FPIES child be most concerned about and what would indicate a nutritional concern?
Our “gold standard” for indicating nutritional concern is the infant’s growth chart. Monitoring the infants’ growth and regular review of dietary intake by a dietitian should indicate if there are any nutritional concerns, which could be further investigated with appropriate blood tests.