Table 3.

Management of acute FPIES episode at a medical facility

	Mild	Moderate	Severe
Symptoms	1–2 Episodes of vomiting and no lethargy	≥3 Episodes of vomiting and mild lethargy	≥3 Episodes of vomiting and severe lethargy, hypotonia, ashen, or cyanotic
Management	1. Attempt oral hydration (e.g., breast-feeding or clear fluids)	1. ≥6 mo: give ondansetron intramuscular (0.15 mg/kg/dose; maximum, 16 mg/dose)	1. Place a peripheral intravenous line and give normal saline solution bolus (20 mL/kg), repeat as necessary
	2. ≥6 mo: consider ondansetron intramuscular (0.15 mg/kg/dose; maximum 16 mg/dose)	2. Consider a peripheral intravenous line for a normal saline solution bolus (20 mL/kg), repeat as necessary	2. ≥6 mo: give intravenous or intramuscular ondansetron (0.15 mg/kg/dose; maximum, 16 mg/dose)
	3. Monitor for resolution; 4–6 hr from onset of symptoms	3. For persistent or severe hypotension, shock, extreme lethargy or respiratory distress, transfer to the emergency department or intensive care unit	3. Consider giving intravenous methylprednisone (1 mg/kg/dose; maximum 60–80 mg/dose)
		4. Monitor vitals	4. Monitor and correct acid base and electrolyte abnormalities
		5. Monitor for resolution at least 4–6 hr from the onset of symptoms	5. Correct methemoglobinemia if present
		6. Discharge home if stable and tolerating clear liquids	6. Monitor vitals
			7. Discharge home, 4–6 hr from onset of symptoms, once at baseline and when tolerating clear liquids
			8. Transfer to emergency department or intensive care unit for persistent or severe hypotension, shock, severe lethargy, respiratory distress

FPIES = Food protein–induced enterocolitis syndrome.

^*Adapted with permission from Ref. 1.