skip to main content

FPIES — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGIFPIESRACP Paediatrics

A 6-month-old presents 2 hours after first exposure to cow's milk formula with profuse vomiting, lethargy, and pallor. There is no urticaria or wheeze. Observations show tachycardia, capillary refill of 4 seconds, and a blood gas shows metabolic acidosis. Skin prick tests to cow's milk are negative. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Food protein-induced enterocolitis syndrome (FPIES)

FPIES (food protein-induced enterocolitis syndrome) is a non-IgE-mediated food allergy presenting with profuse vomiting 1-4 hours after ingestion, often with lethargy, pallor, and hypovolaemia. Skin prick tests and specific IgE are characteristically negative. Common triggers include cow's milk, soy, and grains. Acute management is IV fluid resuscitation.

Reference: RCH Melbourne – 2022 – Non-IgE Mediated Food Allergy CPG; ASCIA – 2024 – FPIES Guidelines