Vomiting in Infancy: Is It FPIES?

Elizabeth Feuille, MD; Anna H. Nowak-Wegrzyn, MD, PhD


January 02, 2019

Key Messages

  • FPIES is a potentially severe non-IgE-mediated food hypersensitivity that typically presents in infancy with profuse emesis, and is often accompanied by diarrhea and lethargy

  • FPIES can be acute or chronic. In acute cases, symptom onset occurs 1-4 hours after ingesting the implicated trigger food; in chronic cases, there is insidious onset with chronic exposure to the trigger food

  • The most common inciting foods for FPIES are cow's milk and soy, followed closely by rice, oats, and eggs. A variety of solid foods such as various meats, fruits, vegetables, and legumes may also trigger FPIES

  • Diagnosis is clinical, based on typical presenting signs and symptoms and the exclusion of other possible etiologies. In unclear cases, FPIES may be confirmed with an OFC. Skin prick and serum IgE testing is not useful in establishing the diagnosis

  • Management of acute reactions hinges on rehydration, which should be performed in a clinical setting if lethargy is present; epinephrine and antihistamines have no role in treating acute FPIES reactions

  • Long-term care involves avoidance of the implicated food, provision of an emergency plan, nutritional counseling, and interval food challenges to assess for resolution

  • Prognosis is generally good; in a majority of infants, FPIES resolves in the first few years of life. Associated IgE sensitization to FPIES trigger foods predicts a more protracted course

The international consensus guidelines are available online in full text and without charge.

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