Get access to over 1,300 articles and reader Q&As.
We’re introducing our baby to solids soon, and in my reading I came across all of this information about FPIES. It really freaked me out! What is it, and is this something I should worry about?
—Scared enough thank you
FPIES stands for “food-protein induced enterocolitis syndrome.” It is a condition, most common in infants, in which a food hypersensitivity generates vomiting, diarrhea, and dehydration. (This is in contrast to other types of food allergies, which cause hives and trouble breathing.) It can be acute or chronic, in which case infants can experience weight loss or failure to thrive. The condition can be thought of as a gastrointestinal food allergy, and it’s most commonly caused by cow’s milk or soy protein, although it can be triggered by other foods (rice, oats, etc.). An infant with this condition will often have a reaction to the offending food, potentially with projectile vomiting.
What is very challenging about FPIES is that it is not easily diagnosed — diagnosis is based on a case history and by testing what happens when you remove the offending food. Unlike a more standard food allergy, a skin prick test will not pick it up, because gastrointestinal allergies are localized in the digestive tract. Difficulties with diagnosis mean it is hard to know exactly the prevalence of this issue, but estimates suggest something between 1 in 1,000 and 1 in 200.
Because there is no direct lab testing, FPIES is frequently misdiagnosed, at least initially. It may appear like a standard gastrointestinal illness, and it is only as time goes on and infants do not improve that it becomes clear there is something more systematic going on.
There is some good news here. Most children grow out of it by the age of 3 (unlike more traditional food allergies, which can be lifelong). In the short term, symptoms can be avoided by avoiding the offending food. A baby with cow’s milk protein-induced FPIES can use soy-based formula. If the offending food is rice, or oats, these can be eliminated and the symptoms will rapidly resolve. Although babies with severe FPIES reactions may need to be hospitalized for dehydration, these symptoms are treatable, so it is typically not life-threatening.
Final note: Although FPIES is rare, a larger share of babies have some milk intolerance, which can cause blood in the stool. Blood in stool as an isolated symptom is not a sign of FPIES. It is worth raising with your doctor, but FPIES would manifest as a more severe set of symptoms, with vomiting being the most common starting point.
Community Guidelines
Log in
My son has FPIES to peanuts. The symptoms are a bit more serious than this article suggests. It takes 3 hours like clockwork for the reaction to start, but then, in addition to projectile vomiting, his heart rate soars, blood pressure plummets, he goes ghostly white, and completely limp, like he can’t even hold his head up. He reacted to a trace amount of peanuts in something I didn’t know contained it once, and he literally had to be taken to the children’s hospital 2 miles away by ambulance because he was at risk of aspirating from the combination of forceful vomiting with limpness. (This was at an age he could sit independently.) His is a severe case, but it can be quite dangerous. The protocol if he were to accidentally ingest peanuts is an immediate dose of zofran and then straight to the nearest ER for 6 hours of monitoring because it basically sends him into shock. Another thing to be aware of is he didn’t respond to peanuts until the 6th time I introduced it, and it only took 1/16 teaspoon to react.
We went through FPIES with our daughter. Had no clue what it was until she had a few vomiting episodes. One piece of it is the reaction happens a couple hours or so after eating the offending food (when it is digested). We switched to only offering new foods in the morning and making sure she had them for a full week before offering at dinner. Had a few scary nighttime vomiting episodes.
I went through an FPIES cows milk allergy scare with my now 2.5 year old.
He was exclusively breast fed until I went back to work at 5 months pp. We introduced regular formula to supplement and the two instances we did he projectile vomited 8 times in a row. But once the “poison” was out of his body, he perked up and was fine. He didn’t need to be hospitalized either time. Out of an abundance of caution, the recommendation was using hypoallergenic formula which we mixed with breast milk and then Pea-Protein milk instead of cows milk at age 1.
Then at 23 months we went on a short hospital stay for 10 hours in which they fed him cows milk and waited for him to throw up.
Nothing happened.
Now he’s a busy, healthy toddler who chugs his cows milk “baba” 3 times a day with zero stomach issues.