Which condition is commonly associated with cow's milk ingestion in toddlers and presents with vomiting and diarrhea?

• A. Food protein-induced enterocolitis syndrome (FPIES)
• B. Celiac disease
• C. Lactose intolerance
• D. GERD

Answer: (A)

This is about a non-IgE–mediated reaction to cow’s milk that presents with vomiting and diarrhea after milk ingestion in toddlers. The hallmark is gastrointestinal symptoms that occur within hours of consuming milk, often with pallor and irritability, and sometimes dehydration or poor weight gain. This pattern fits cow’s milk–triggered enterocolitis syndrome (FPIES), which is not driven by typical allergic hives or wheezing but by a different immune mechanism causing acute GI distress after exposure. Eliminating cow’s milk protein from the diet usually resolves the episodes, and diagnosis can be supported by history and, if needed, supervised oral food challenge.

In contrast, celiac disease is gluten-driven and presents with chronic malabsorption symptoms rather than an acute vomiting/diarrhea reaction tied to milk. Lactose intolerance causes diarrhea and GI symptoms after lactose-containing foods due to lactase deficiency, but it’s not characterized by the sudden, projectile vomiting and dehydration seen with FPIES. GERD involves reflux and regurgitation rather than a distinct postmilk enterocolitis reaction.