Key takeaways: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE food allergy that causes repeated, severe vomiting usually 1 to 4 hours after eating a trigger food, often with paleness and lethargy. Common triggers include cow’s milk, soy, rice, and oats. It can cause dehydration and shock and needs emergency care. Most children outgrow it.
FPIES is less known than typical food allergies but important to recognize.
How It Differs From Typical Allergies
- Typical (IgE) food allergy: hives, swelling, and breathing symptoms within minutes to 2 hours.
- FPIES: delayed vomiting, usually 1 to 4 hours after eating, without hives or swelling. Allergy skin and blood tests are usually negative.
Signs of Acute FPIES
- Repeated, often forceful vomiting 1 to 4 hours after eating.
- Pale or gray color.
- Lethargy or floppiness.
- Diarrhea, sometimes later.
- Low blood pressure or low body temperature in severe cases.
Common Triggers
According to the 2017 international consensus guidelines:
- Cow’s milk.
- Soy.
- Rice.
- Oats.
- Other foods like egg, fish, and some fruits and vegetables.
Diagnosis
FPIES is diagnosed based on symptoms and history. Your doctor may refer you to an allergist.
Treatment
- Emergency care for severe reactions: IV fluids and sometimes medication (ondansetron).
- Avoid trigger foods.
- An emergency plan from your allergist.
- Introduce new foods carefully, as advised.
Outlook
Many children outgrow FPIES, often by school age. Allergists may perform supervised food challenges to see if the allergy has resolved.
Seek emergency care if your baby: has repeated vomiting, is pale, floppy, or very sleepy after eating, or shows signs of dehydration.
The Bottom Line
FPIES causes delayed, repeated vomiting after eating trigger foods. Seek emergency care for severe reactions and work with an allergist.
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Sources
- Nowak-Węgrzyn A, Chehade M, Groetch ME, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary. J Allergy Clin Immunol. 2017;139(4):1111-1126.e4.
- American Academy of Allergy, Asthma and Immunology. Food protein-induced enterocolitis syndrome (FPIES). https://www.aaaai.org
- International FPIES Association. https://fpies.org
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
