Table 1.

Diagnostic criteria for patients presenting with possible acute food protein-induced enterocolitis syndrome FPIES (from reference [1]).

Major criterion

•   Vomiting in the 1–4 h period after ingestion of the suspect food and the absence of classic IgE-mediated allergic skin or respiratory symptoms.

Minor criteria

A second (or more) episode of repetitive vomiting after eating the same suspect food; Repetitive vomiting episode 1–4 h after eating a different food; Extreme lethargy with any suspected reaction; Marked pallor with any suspected reaction; The need for an emergency room visit with any suspected reaction; The need for intravenous fluid support with any suspected reaction; Diarrhea in 24 h (usually 5–10 h); Hypotension; Hypothermia.

The diagnosis of FPIES requires that a patient meets the major criterion and ≥3 minor criteria. If only a single episode has occurred, a diagnostic OFC should be strongly considered to confirm the diagnosis, especially because viral gastroenteritis is so common in this age group. Furthermore, although not a criteria for diagnosis, it is important to recognize that acute FPIES reactions will typically completely resolve over a matter of hours compared with the usual several-day time course of gastroenteritis. The patient should be asymptomatic and growing normally when the offending food is eliminated from the diet.