Vomiting in Infancy: Is It FPIES?

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


January 02, 2019

What Foods Should Be Avoided?

Strict avoidance of the suspect food is recommended. While infants with FPIES typically tolerate the food in trace amounts,[14] a minimum eliciting dose can be difficult to ascertain because of delays in symptom onset.

Exposure to the inciting protein in breastmilk is tolerated by the majority of infants. However, FPIES occurring in exclusively breastfed infants with maternal ingestion of cow's milk or soy has been reported in as few as 2% of patients in a US study and in as many as 10% of infants in a study in Japan.[3,4,15]

Numerous studies have established that a majority of children with IgE-mediated cow's milk and egg allergy will tolerate baked products containing those ingredients. In contrast, although one small case series[16] showed that some patients with cow's milk and egg FPIES can tolerate baked goods, there is no conclusive evidence that infants with FPIES can tolerate a trigger food in baked products. Therefore, the consensus guidelines recommend that patients avoid ingesting baked goods containing cow's milk and egg until they undergo a clinician-supervised OFC.[1]


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