What is Multiple Food Protein Intolerance?

Multiple Food Protein Intolerance of Infancy is characterized by (1) the body’s inability to tolerate a variety of food proteins (read: lots of different foods make the child sick) with a presentation in early infancy, (2) onset in early infancy, and (3) symptoms resolve on a hypoallergenic diet. 

Symptoms appear after ingesting a food that a child is sensitive to.  Symptoms are often delayed. A 2 -4 hour delay after ingestion is common but symptoms can be delayed as much as 2 days after consumption.  Symptoms can also appear immediately after ingesting an offending food.  This wide range in symptom presentation can make diagnosis difficult.

Lots of children are lucky enough to grow out of their MFPI symptoms by age 3, but some will never lose all of their intolerances.

Symptoms

The possible symptom list is long, and includes:

  • Eczema and skin rashes 
  • Reflux
  • Vomiting
  • Fatigue
  • Diarrhea and Constipation
  • Gassiness and stomach discomfort
  • Behavioral: Irritability /”fussiness”, anxiety
  • Mucous and / or blood in the stool
  • Congestion and / or wheezing
  • Itchy eyes and nose
  • Sleeplessness
  • Malabsorption Syndrome / Failure to Thrive

Your child may have some or all of these symptoms.  Some symptoms will appear with some foods, but not with others.  For example, eating dairy may cause gastrointestinal upset while eating oats may cause congestion and itchy eyes and nose (or vice versa). If an infant is sensitive to a particular food, then he or she may be fussy and / or gassy after feedings, sleep very little or restlessly, and cry for long periods.  

 

Diagnosis

Diagnosis can be difficult.  The American Academy of Allergy Asthma and Immunology describes Multiple Food Protein Intolerance as, “a severe form of non-IgE mediated food allergy”.  This means that allergy tests such as the Skin Prick Test (SPT) and RAST blood test will not be useful as they test for histamine (IgE mediated) reactions. There are no tests for Multiple Food Protein Intolerance.  Diagnosis is usually based on patient history and physical examination (to rule out other potential causes for the symptoms).

 

Common Triggers

The foods that are most often problematic are:

  • Dairy
  • Eggs
  • Soy
  • Peanuts

While those are the most common, the other four foods of what are known as the “Big 8” of allergens are also common.  These are:

  • Fish
  • Shellfish
  • Tree Nuts
  • Wheat

That being said, ANY food can be a trigger food and often many children with MFPI will only have a small handful of “safe” foods that they don’t react to, especially in the first year.

 

Treatment

The only treatment is to avoid the offending foods.  Total Elimination Diets (TEDs) are highly successful.  For mothers that are breastfeeding, both mother and infant (if eating solids) have to perform the eliminations in order to remove the substance(s) from the infant’s system.  It can take up to 3 to 5 weeks of a hypoallergenic diet to completely remove all traces of the offending foods from the mother and baby’s system (2-3 weeks for the mother and then an additional 2 weeks for the infant).

 

Additional Information

Protein Intolerance Clinical Presentation

NIH Info

Big 8 Allergens

Kelly Mom – Signs of Food Sensitivities

How long does it take for food to get into my breast milk?

 

How MFPI Relates to MSPI and FPIES

 

Milk Soy Protein Intolerance (MSPI)

Milk Soy Protein Intolerance is nearly identical to MFPI except that the trigger foods are restricted to milk and soy derived products.  Symptoms and treatment are otherwise the same.

 

Food Protein Induced Enterocolitis Syndrome (FPIES)

FPIES is very similar to Multiple Food Protein Intolerance.  Both are non-IgE mediated food allergy responses.  I have come across several discussions regarding FPIES, MSPI, and MFPI being a spectrum of disorders (with MSPI on one end and FPIES on the most severe end), as well as MSPI and MFPI being subsets of FPIES. I can see the sense in this and have no arguments against why that wouldn’t be the case, however, I have not personally read anything in the medical literature yet that confirms this hunch that many parents have expressed.

That being said, there are some noteworthy distinctions between FPIES and MFPI / MSPI. FPIES reactions / symptom onset is more characteristically delayed by 2-3 hours after ingesting a trigger food.  Vomiting, especially profuse vomiting to the point of dehydration and lethargy are often considered the hallmarks of FPIES.  Some FPIES reactions are so severe that when parents bring the child to the Emergency Room they are mistakenly diagnosed with sepsis.

 

Symptoms

The FPIES Foundation separates symptoms into acute vs chronic.  The following is directly from their website:

Acute Symptoms include:

  • Repetitive vomiting (~1-6 hrs post ingestion)
  • Diarrhea (~2-10hrs post ingestion)
  • Dehydration (following vomit and diarrhea)
  • Lethargy (with vomiting)
  • Pallor (pale skin, blue/grey tones)
  • Low Blood pressure (hypotension)
  • Low Body Temperature (hypothermia)
  • Abdominal distension

Chronic Symptoms include:

  • Intermittent/Chronic vomiting
  • Weight loss
  • Failure to Thrive
  • Chronic watery diarrhea with blood/mucus
  • Lethargy
  • Pallor
  • Abdominal distension

 

Common Triggers

The FPIES Foundation states that the most common trigger foods for FPIES are:

  • Milk / Dairy
  • Rice
  • Oats
  • Soy
  • Barley
  • Meat (poultry, red meat, pork, etc)
  • Green Peas
  • Green Beans
  • Sweet Potatoes
  • Squash

“However, any food protein can be a trigger and some infants may be sensitive to other foods as well. In addition, some children may react to one or two foods whereas others may experience reactions to multiple foods.”

In addition, chronic FPIES (as opposed to acute FPIES) may not exhibit any vomiting.

To learn more about FPIES visit The FPIES Foundation.