Hypotension and Shock

It is estimated that up to 10% of FPIES reactions in adults may result in low blood pressure or shock. The term “shock” is used to refer to poor blood circulation from a variety of causes. It is not completely understood why FPIES reactions sometimes lead to low blood pressure. You may be at risk for shock if you are having vomiting and/or diarrhea and are not able to take in fluids to rehydrate your body.

If you are too nauseous to take small sips of fluids, or if you are vomiting too much to drink any fluids then you should seek care in an emergency room.  Symptoms of low blood pressure and shock can include: lightheadedness, pale or bluish skin, agitation, lethargy, confusion or reduced consciousness, and shallow breathing. If one feels for a pulse, it may be faster and weaker feeling than usual. If you have these symptoms and you can’t drink enough fluids, seek medical attention.


Thankfully, there are no reported deaths from FPIES, but hypotension and shock are dangerous.

When blood circulation is compromised, the vital organs get less oxygen and nutrients than normal. A serious FPIES reaction requires immediate attention.

The primary treatment for hypotension and shock during a serious FPIES reaction is intravenous fluids (medical fluids given through a catheter into a vein). This treatment adds to the blood volume and improves the circulation.

There are additional medications that can be given in an emergency room to help support blood circulation, but typically patients respond very well to the intravenous fluids.

Epinephrine given by autoinjector for typical allergic anaphylaxis has not been studied for hypotension/shock in FPIES. Because this medication works by strengthening the heart beat and blood vessels, but does not replace the missing fluids, experts do not feel that epinephrine should be depended upon as a treatment for FPIES reactions.

Provided by the I-FPIES Medical Advisory Board

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