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Table 2 Diagnostic criteria of acute FPIES (from reference [1], modified)

From: FPIES in exclusively breastfed infants: two case reports and review of the literature

The diagnosis of acute FPIES requires the presence of vomiting (1–4 h after the ingestion of the suspected food) and the absence of classic IgE mediated allergic skin respiratory symptoms (major criteria), plus at least three of the following minor criteria:
A second (or more) episode of repetitive vomiting after eating the same suspected food
Extreme lethargy with any suspected reaction
Marked pallor with any suspected reaction
Need for Emergency Department visit with any suspected reaction
Need for intravenous fluid support with any suspected reaction
If only a single FPIES reaction has occurred, it is strongly recommended to perform a diagnostic food challenge