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You are seeing a 10 month old female with profuse projectile vomiting and one episode of diarrheal stool over the last 2 hours. She is ill-appearing and has signs of significant dehydration. While obtaining vascular access and rehydrating her, you obtain additional history and peruse her chart. She has had three prior similar but more mild episodes, all diagnosed as acute gastroenteritis, starting at age 7 months. This episode began ~90 minutes after the family had dinner. The family had peanut chicken curry over rice and a salad. The baby had rice and small pieces of chicken set aside before being mixed with the peanut curry sauce. The baby has a 3-year-old sister in preschool. She is asymptomatic.
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July 4, 2023 at 11:04 pm
B) Food protein-induced enterocolitis syndrome (FPIES)
FPIES is a non-IgE mediated food sensitivity. It is uncommon, but not rare, with an incidence of 0.015 to 0.7% depending on the population. While milk and soy are the most common triggers, with symptoms manifesting in infancy, solid foods such as grains (rice in our case), eggs, fish, and other foods can be triggers. Peanuts are not a typical trigger for FPIES. Initial exposures may result in milder episodes of vomiting and watery mucusy stools. Ultimately, ingestion results in an acute presentation of profuse projectile vomiting within 1-4 hours of ingesting the offending food, and diarrhea within 2-10 hours. Patients may present with hypovolemic shock.