One of the biggest challenges parents face when trying to figure out FPIES for their kids is trying to figure out what foods to trial next. When you have a child that reacts to a wide range of foods, there is always an underlying sense of fear and uncertainty surrounding new foods. Sometimes it feels like walking through a minefield blindfolded. Knowing which foods pose the biggest risks could help minimize or avoid potential reactions.
Some of the most common FPIES trigger foods include:
- Rice
- Oats
- Dairy (cow milk)
- Soy
- Fish
- Sweet Potatoes
- Chicken
- Beef
- Corn
- Egg
- Peanuts
- Bananas
- Avocado
There are a number of other triggers that are also common, including (but not limited to) squash, barley, green beans, watermelon, peaches, peas, quinoa, goat’s milk, and strawberries. These are some of the most common triggers I’ve seen in research articles and heard of from other parents, but it is not an exhaustive list. Any food could potentially be a trigger food for Fpies.
What are low risk foods for FPIES?
When we saw the allergist for my daughter’s diagnosis, we were given a list of foods to start with when we started solids. The list included yellow and green veggies, as well as fruits like melons. We diligently tried all of these foods, and avoided rice and oats, and…. Guess what? Some of the foods on the list of “safe” foods were our biggest fails. My daughter is 4 now and still has some of these yellow veggies (peppers and some types of squash) as trigger foods.
Squash, sweet potato, and several of the green veggies like green beans and peas that we were advised to trial first are actually some of the bigger FPIES trigger foods.
So, what foods are low risk foods to try?
Unfortunately, the answer is…it depends. Some kids will only react to one or two foods, some kids react to a bunch. Some kids will react to a whole category or family of foods, and other kids will only react to one food in a family and there seems to be no rhyme or reason to what foods they fail.
Some foods that seem to have a higher pass rate are:
Apples
Pumpkin
Blueberries
Blackberries
White Potato
Pear
Pork
Butternut squash
Asparagus
Quinoa
Coconut
Venison
Bison
Almond
Millet
Broccoli
Cabbage
Pomegranates
Cassava/yuca
Foods that could go either way
There are some foods that could very well go on either of these lists. These are the foods that have a high pass rate but also a large fail rate. They honestly could go either way for any given person.
How to use food families to guide future trials
If you have a child that seems to react to a lot of different foods, it can be helpful to look at the types of foods that are causing reactions to look for patterns. For our family, having a great nutritionist was so valuable for helping us with this. I have learned a lot about foods and their families and protein structures over the last few years, but when I was just starting on this journey everything felt so overwhelming. It was really helpful to have someone to help guide us.
So, what are food families? This is just what it sounds like – foods that are in the same class.
For example, if your child has reactions to carrots, potatoes, and onions, you might want to avoid other root vegetables for a while. Other root veggies include parsnips, turnips, and celery.
If tomatoes and white potatoes cause a problem, you could watch for reactions from other types of nightshades like eggplant, bell pepper, and paprika.
It can help you figure out which foods might be safe food as well – so if your child is ok with peaches and plums, maybe try other stone fruits. If they do well with strawberries and blackberries, maybe try raspberries and see how that goes. If they fail banana, they might fail avocado as well because the protein structures are really similar. If they pass one, they might pass the other as well.
Again, this is all very individual-specific….this is just a guide based on what types of foods are similar, not a guaranteed list of passes or fails.
This is FPIES – try EVERYTHING.
What are some examples of food families and cross reactors?
- Grains – these are notoriously hard for kids to digest and pass early on. However, there are lots of kids that pass wheat or rice early on even though for other kids they are triggers.
Some examples of grains are: wheat, oats, rice, corn, barley, sorghum, rye, and millet.
- Stone fruits – these are fruits with a pit (stone) in the middle.
Examples include: peaches, nectarines, plums, lychees, mangoes, almonds, cherries, apricots
- Latex cross reactors – these are foods that have protein structures similar to what is found in latex. People with a latex allergy are more likely to react to these cross reactors than the average person.
Examples: Avocado, Banana, Kiwi, Apple, Carrot, Celery, Chestnut, Papaya, Potatoes, Tomatoes, and Melons
- Root veggies – White potatoes, Sweet potatoes, Radishes, Rutabaga, Parsnips, Jicama, Beets, Shallots, Garlic
- Nightshades – cayenne pepper, chili powder, curry powder, eggplant/aubergine, Goji berries, Pimentos, Potatoes, Paprika, tomatoes, tomatillos
- High histamine foods – fermented or pickled foods, soybeans, chickpeas, lentils, yogurt
- Faux grains or ancient grains – quinoa, amaranth, buckwheat, spelt, millet, chia, and teff
One of the most frustrating things for me when we were starting on this journey was that my children failed food after food after food for about 10-12 months. Sometimes it would be an entire family of foods that they would fail- for example my son went a long time without being able to do any fruits or green vegetables. My daughter went a long time without being able to do any type of poultry or turkey.
But sometimes, they would pass one food and fail another food that was extremely similar. For example, my daughter went a long time with lemons as a safe, but limes were a trigger. This is the part of fpies that can be confounding, frustrating, and isolating. Most of the time, friends and family don’t understand, because this doesn’t the “normal” picture of what allergies look like. Nothing about FPIES fits a “normal” description of allergies, if you ask me. That’s part of the reason this site exists – there are tons of parents and grandparents out there struggling alone because their child is sick and this doesn’t fit a normal allergy profile.
All of that to say, there are no hard and fast rules about FPIES. What is safe for one child may not be safe for another, even in the same family. You are more than welcome to use these lists as a guide or a starting point, but I encourage you to do your research, learn your child’s reaction patterns and the types of foods that they are more likely to react to, and just use your best judgment. There will be times when you choose a food that turns out to be a massive fail, and there will also be times when you try a food that you are fairly certain is going to end really badly, and it turns out as a surprise safe food. One of the good things about fpies is that it teaches you to be prepared for the worst, but also to celebrate small wins and victories that you may not expect. You’ve got this.