[An acute vomiting infant with profuse diarrhoea: enterocolitis due to non-IgE-mediated cow's milk allergy].

Background: Food protein-induced enterocolitis is a manifestation of non-IgE-mediated cow's milk allergy, characterized by acute vomiting and profuse diarrhoea. This reaction is often not recognized as cow's milk allergy.
Case Description: We present a 6-week-old, formula-fed girl with frequent vomiting, diarrhoea and failure to thrive. These symptoms disappeared after giving cow's milk-free formula. Forty-five minutes after the last dose in a non-blinded provocation test with cow's milk, she developed profuse diarrhoea and vomiting, resulting in hypovolemic shock. No specific IgE against cow's milk was found.
Conclusion: Unusual in this case is the severe but relatively late reaction to the provocation test. In an acutely ill infant with vomiting, diarrhoea and pallor - which can even result in shock - food protein-induced enterocolitis as manifestation of non-IgE-mediated allergy must be considered. These symptoms start as late as 2 to 3 hours after exposure and disappear after withdrawal of the causal product.