Non-IgE mediated mast-cell degranulation

exposure (new, old, prev tolerated, ingredients, through breastmilk) dairy, soy, wheat, sesame, shellfish, oat, rice TIMING and duration of symptoms post exposure occured before? consistent? cofactors? GI: diarrhea, vomiting, bloody stool, abdo pain, distention, dysphagia red flag IgE? cardiac, derm, resp FAILURE TO THRIVE? height weight as expected? ED visit

DDx: FPIES: vomiting/lethargy 1-3h, maybe diarrhea/hypotension. May have FTT. CMPA: bloody stool first few months life no FTT prognosis good FPIE: diarheaa, abdo pain, distention EDU:

The only true diagnostic test for FPIES or similar non-IgE mediated reactions is an oral challenge; however, this is only usually done if history is insufficient.

We will send for celiac serology and a CBC Strict avoidance of: In the case of repeat reaction, it is important to rehydrate as tolerated; there is a low-threshold to present to the ER in case of uncontrollable volume loss or worsening lethargy. For FPIES, administration of Ondansetron can be considered Although unpleasant, these non-IgE reactions are not associated with progression to anaphylaxis and as such no epinephrine autoinjector is needed