From:  Diagnosing cow’s milk allergy with the EATERS-X allergy-focused clinical history

 Scenario 4: non-IgE CMA-FPIES.

EATERS-X abbreviationInformation from the history taking
E (Environment)Breastfed infant at 6 months old when cow’s milk was introduced directly (*).
A (Allergen)Cow’s milk protein in formula and milk in solid foods.
T (Timing)Symptoms occurred 2 to 4 hours after consuming cow’s milk.
E (Exposure)Three oral direct exposures. Mum had been breastfeeding with cow’s milk in her diet since birth, with no symptoms; they only started when direct cow’s milk was introduced to the child.
R (Reproducibility)Three episodes of increasing severity, symptoms improved with CM exclusion (home reintroduction is not recommended if FPIES—if suspected, refer for specialist advice).
S (Symptoms)Persistent vomiting after feeds, effortless and profuse, the child became pale and floppy, with delayed diarrhoea 12–18 hours later on 2 occasions. No fever or rash on any occasion.
X (Extra/Rx)First episode observed at home, thought may have had gastroenteritis. Second episode, contacted GP for advice. In the third episode, the child became floppy and unresponsive and presented to the emergency department. An oral fluid trial was performed, and observed. Diagnosis made by staff, although the parent had suspicions based on an internet diagnosis.
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*: FPIES also occurs in formula-fed infants, where symptoms can be protracted. CMA: cow’s milk allergy; FPIES: food protein-induced enterocolitis syndrome.