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Food Protein-Induced Enterocolitis Syndrome (FPIES) in Children

Non-IgE-mediated food allergy of infancy and early childhood characterized by repetitive vomiting, lethargy, and pallor occurring 1 to 4 hours after ingesting trigger foods such as cow milk, soy, rice, oat, fish, and egg.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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What is Food Protein-Induced Enterocolitis Syndrome (FPIES) in Children?

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated cell-mediated food allergy characterized by intestinal inflammation after ingestion of cow milk protein, soy, rice, oat, egg, or fish in infants and toddlers.

Acute FPIES presents 1 to 4 hours after ingestion with profuse repetitive vomiting, pallor, lethargy, and sometimes hypotension, while chronic FPIES presents with intermittent vomiting, diarrhea, and failure to thrive.

Diagnosis is clinical based on Powell criteria; serum IgE testing and skin prick are typically negative; oral food challenge under medical supervision confirms the trigger.

Symptoms

Profuse repetitive vomiting 1 to 4 hours after eating the trigger food
Pallor, lethargy, and hypotonia in acute episodes, occasionally hypotension
Diarrhea hours after vomiting in some children
Failure to thrive, poor weight gain, and chronic diarrhea in chronic FPIES
Resolution of symptoms within 24 hours after avoiding the trigger

Risk Factors

Age younger than 2 years for cow milk and soy FPIES
Older infants and toddlers introduced to solid trigger foods (rice, oat, fish, egg)
Atopic dermatitis or family history of atopy
Recent introduction of new foods, especially first exposure
Coexisting non-IgE-mediated gastrointestinal disorders

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Repetitive vomiting and pallor or lethargy after eating in infancy
  • Suspected dehydration, lethargy, or shock — emergency evaluation
  • Failure to thrive or persistent diarrhea after introducing solid foods
  • Plan for safe reintroduction or oral food challenge under specialist care

Treatment Methods

01
Acute episode treatment — IV isotonic fluid bolus, ondansetron, and observation
02
Strict avoidance of the trigger food and hidden derivatives
03
Hypoallergenic infant formula (extensively hydrolyzed or amino acid-based) for cow milk FPIES
04
Stepwise introduction of low-risk foods using a structured FPIES-safe schedule
05
Supervised oral food challenge every 12 to 18 months to assess tolerance acquisition with most resolving by age 3 to 5 years

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Çocuk Sağlığı ve Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.