FPIES: The 'Other' Food Allergy

Anna Nowak-Wegrzyn, MD


April 03, 2013

Which Child Has FPIES?

The infant described in the second scenario is exhibiting solid-food FPIES to rice. The situation described in the fourth scenario is typical of chronic FPIES to CM-based formula. The first child likely has proctocolitis, while the third child is manifesting typical symptoms of infantile colic.

What Is Going on With This Baby?

Emma, a full-term female thriving infant, was initially exclusively breastfed. Following introduction of CM-based formula supplementation at 4 weeks of age, she developed frequent episodes of emesis, poor weight gain, and watery stools with occasional mucus over the 2-week period following initiation of daily formula intake.

She was then returned to exclusive breastfeeding with improvement in her symptoms and renewed weight gain, until 1 feeding with a CM-based formula at 12 weeks of age. Approximately 90 minutes after that feeding, she developed repetitive emesis (10-15 episodes that eventually produced bilious content) and became lethargic. A full sepsis workup, toxicology, and metabolic screening were done in the emergency department (ED). She had an elevated white blood cell count with a left shift in the differential. She received intravenous (IV) fluid resuscitation and antibiotics and was observed in the hospital for 3 days. Blood-tinged diarrhea was noted on only the first hospital day. She tolerated a hypoallergenic, extensively hydrolyzed casein-based formula and was discharged after 3 days with negative cultures and a presumptive diagnosis of viral gastroenteritis.