Food Protein-Induced Enterocolitis Syndrome (FPIES)

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What is FPIES?

FPIES is a non-IgE-mediated food allergy typically presenting in infancy. In formula fed infants, FPIES is commonly triggered by cow's milk or soy protein.

Nutritional Management of FPIES

  • After diagnosis of FPIES, continued avoidance of food(s) until physician has determined reintroduction is appropriate
  • Food reintroduction is almost always performed in a controlled setting due to possible severe, acute symptoms
  • Infants with cow’s milk/soy FPIES may be breastfed or use a hypoallergenic formula1,2 such as:
    ⁃ Extensively hydrolyzed formula
    ⁃ Amino acid-based formula

What is a typical FPIES reaction?

The range, severity and duration of symptoms vary from child to child. They
may include:

  • Delayed onset vomiting
  • Increase in reflux and runny stools
  • Diarrhea
  • Dehydration
  • Shock

Acute FPIES - Clinical Features2

Mild-to-Moderate Symptoms
    • Vomiting (onset usually 1-4 hours after ingestion of food; can range from 30 minutes to 6 hours)
    • Few, intermittent vomiting episodes (1-3), can be bilious

    Decreased activity level


    Self-resolving: child is able to tolerate oral rehydration at home

    Severe Symptoms
      • Vomiting (onset usually 1-4 hours after ingestion of food; can range from 30 minutes to 6 hours)
      • Projectile (forceful) in nature
        Repetitive (>4) episodes; bilious and dry heaving

      Activity level ranges from decreased to lethargy


      Dehydrations requiring intravenous hydration

      Chronic FPIES - Clinical Features2

      Mild Presentation
        • Lower doses of the trigger food (i.e. solid foods or food allergens in breast milk) lead to intermittent vomiting and/or diarrhea
        • Typically poor weight gain/failure to thrive but without dehydration or metabolic acidosis
        Severe Presentation
            • When trigger food is ingested on a regular basis (i.e. infant formula), intermittent but progressive vomiting and diarrhea (blood may be present)
            • Sometimes dehydration and metabolic acidosis may occur

            Did You Know?

            Tolerance in infants/children with cow milk-induced or soy-induced FPIES have been reported to occur at an earlier age than other foods.2

            How EleCare® and EleCare® Jr may help

            EleCare and EleCare Jr are nutritionally complete, hypoallergenic, amino acid-based formulas. Both support growth when used as the primary source of nutrition.3,4,* EleCare is clinically shown to significantly improve symptoms in infants and children with malabsorption issues and short bowel syndrome.5,*

            For more information about FPIES, check out:

            The FPIES Foundation

            The FPIES Foundation gives people living with food protein-induced enterocolitis syndrome the tools and confidence they need to achieve normalcy in their lives.

            Kids With Food Allergies (KFA)

            Learn how to improve the day-to-day lives of children with food allergies and empower them to create a safe and healthy future.

            The Food Allergy & Anaphylaxis Network

            Get the facts on what food allergies are – and what they aren’t. And learn how to recognize the symptoms and seek testing from a healthcare professional.

            Kaareen’s Story

            Learn how EleCare helped support the nutrition of a patient, and helped them get back to loving life.

            Other Conditions

            Food Allergies

            Your child is not alone. In fact, it’s estimated that 4 out of every 100 children in the US have food allergies.6

            Short Bowel Syndrome (SBS)

            Short bowel syndrome describes a group of problems affecting individuals who have lost the use of a major part of their small intestine.

            Malabsorption and Other Conditions

            Malabsorption means that a child's body has trouble absorbing nutrients from food.

            Eosinophilic Gastrointestinal Disorders (EGIDs)

            EGIDs are chronic digestive system disorders in which certain food proteins trigger an overproduction of eosinophils (a type of white blood cell) in different areas of the digestive tract.

            References: 1. Nowak-Wegrzyn A, et al. J Investig Allergol Clin Immunol. 2017;27(1):1-18. 2. Nowak-Wegrzyn A, et al. J Allergy Clin Immunol. 2017;139(4):1111-1126. 3. Sicherer SH, et al. J Pediatr. 2001;138(5):688-693. 4. Borschel MW, et al. Clin Pediatr. 2013;52(10):910-917. 5. Borschel MW, et al. BMC Pediatrics. 2014;14:136. 6. Branum AM, Lukacs. Food allergy among US children: Trends in prevalence and hospitalizations. NCHS data brief, No. 10. Hyattsville, MD: National Center for Health Statistics. 2008. Centers for Disease Control and Prevention, National Center for Health Statistics website. Published October 2008. Accessed March 20, 2024.

            Use under medical supervision.