• FPIES stands for Food Protein-Induced Enterocolitis Syndrome.
  • FPIES is a delayed type of allergic reaction that happens after eating a certain food. Trigger foods cause parts of the intestines to swell and get irritated.
  • Common FPIES symptoms include throwing up, diarrhea, stomach pain, becoming pale and very tired (lethargic).
  • Reactions can range from mild to life-threatening. Children with FPIES can dehydrate quickly and may go into shock.
  • Most reactions start 2 to 3 hours after eating a trigger food. A child can react up to 8 hours after eating the food.
  • Most times children have only one trigger food. However, it’s not uncommon to react to more than one trigger food with FPIES.
  • Milk, soy, and rice are common triggers. Some less common triggers are oats, barley, beef, chicken, turkey, sweet potato, squash, peas, and lentils. Any food can be a trigger.


  • Avoid eating trigger foods. Some infants might need special formula.
  • Breastfeeding mothers should not avoid an infants trigger foods unless the infant has had a past reaction to the food in breast milk.
  • There are no blood or skin tests for FPIES. A food challenge helps find out if your child has FPIES to a food. It can also help find out if he or she has outgrown FPIES.
  • Food challenges happen in a clinic or hospital while an allergist or nurse is with you.
  • Most children outgrow FPIES around age 2-3 years old. FPIES in adults is very rare.
  • A written plan for your child’s FPIES can be helpful for people treating your child in an emergency.
  • FPIES can be mistaken for severe infections (sepsis), food poisoning, anaphylaxis, or stomach problems needing surgery.



  • In FPIES, the body loses fluids and may become very dehydrated. This can lead to shock. Shock is a life-threatening medical emergency.
  • Shock happens when the body cannot get enough blood and oxygen to its brain and other organs.
  • Symptoms of shock include:
  •  Cool, pale, clammy skin
  •  Getting weak, dizzy, or confused
  •  Being fearful or restless
  •  Fast, weak pulse
  •  Quick, shallow breathing
  •  Fainting
  •  Less urine or darker urine
  •  Low blood pressure
  • If your child has eaten a trigger food consider getting emergency help even before a reaction starts.
  • Children can get very sick very quickly and need emergency help.
  • If you think your child is in shock, call 911 or get emergency help right away.


FPIES and anaphylaxis are different kinds of allergies. Anaphylaxis is a severe allergic reaction that can cause death within minutes unless treated right away.

FPIES is more delayed but can be just as life-threatening.


FPIES chart

Rarely children with FPIES may also have symptoms of anaphylaxis, or may start having anaphylaxis to trigger foods. Allergists often do tests to check for anaphylaxis to trigger foods before a child tries them again.