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FPIES (delayed food allergy with vomiting in babies)

Also called: FPIES, food protein-induced enterocolitis syndrome

A delayed food allergy in babies causing repeated, severe vomiting 1 to 4 hours after eating a trigger food like milk, soy, rice, or oats. It isn't the hives-type allergy.

Timing1 to 4 hours after the food
Common triggersCow's milk, soy, rice, oats
OutgrownUsually by age 3 to 5

Overview

Babies can become pale, floppy, and dehydrated after vomiting.

Allergy skin and blood tests are usually negative.

Symptoms

Common signs:

  • Repeated vomiting hours after a food

Less common

  • Pale, floppy, or very sleepy
  • Diarrhea

Look up a symptom: Diarrhea · Vomiting

When to get medical care

Call 911A baby who is limp, very pale, or not responding after vomiting.
Get care todayRepeated vomiting after a new food.
See a doctor soonPlanning new foods.

Causes

Immune reaction in the gut.

Does it spread or run in families?

  • It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

  • Babies starting solids

Diagnosis

A clinician asks about your symptoms and may order tests.

The exam

A physical exam.

Tests

Tests, if needed:

  • Diagnosis by history:
  • Supervised food challenge: Later, to check if outgrown.

Treatment

Treatment depends on the cause and how severe it is.

Self-care

  • Avoid the trigger food
  • Have an emergency plan from your doctor
  • Introduce new foods one at a time

Which doctor treats this

  • Start with your child's pediatrician.
  • They may send you to a pediatric specialist: an allergist (allergy and asthma doctor).

Living with it

  • Read every food label.
  • Carry two epinephrine auto-injectors at all times.
  • Tell restaurants about your allergy.
  • Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

Back to school, work, or sports

  • Most people can keep working or going to school.
  • Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

For caregivers

  • Learn the warning signs and when to call the doctor or 911.
  • Keep a list of your child's medicines, doses, and doctors on your phone.
  • Tell teachers, coaches, and sitters what to watch for and what to do.
  • Take breaks and ask for help. Caregivers need care too.

Outlook

Most children outgrow it.

Getting ready for your visit

Bring a list of your symptoms and medicines.

What to bring

  • A list of your medicines and supplements
  • Notes on when symptoms started and what makes them better or worse

Questions to ask

  • What's causing this?
  • What treatment do you recommend?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on FPIES (delayed food allergy with vomiting in babies)

Sources

Last updated 2026-11-12.