Vomiting, Lethargy and Pallor

  • Melanie A. RuffnerEmail author
  • Terri F. Brown-Whitehorn

Practical Points

  • Food protein-induced enterocolitis (FPIES) syndrome typically presents with a delayed onset of vomiting beginning 1–4 h after ingestion of the offending food(s)

  • Classic IgE mediated symptoms including hives, flushing or respiratory symptoms are absent in FPIES

  • Rarely, chronic forms of FPIES can present with frequent antigen exposure/ingestion and are characterized by vomiting, diarrhea, weight loss and failure to thrive

  • Treatment of FPIES is by removal of the offending food(s) from the diet and supportive care as needed for dehydration and to optimize nutrition

  • Diagnosis of FPIES is based on clinical features

  • Skin testing and specific-IgE testing do not predict FPIES triggers and have little utility in this non-IgE-mediated disorder

  • Prognosis of FPIES in children is generally good and the majority of patients will tolerate the offending food(s) after a period of avoidance


Food-protein induced proctocolitis Food protein-induced enterocolitis IgE mediated food allergy Skin prick test 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Melanie A. Ruffner
    • 1
    • 2
    Email author
  • Terri F. Brown-Whitehorn
    • 1
    • 2
  1. 1.Division of Allergy and ImmunologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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