Paediatric allergy · London
Non-IgE mediated food allergy clinic (FPIES) - London.
A calm, joined-up clinic for babies and toddlers with delayed food reactions - profuse vomiting hours after a feed, blood in the nappy of a thriving baby, or chronic diarrhoea with poor weight gain. A named paediatric allergist, a paediatric gastroenterologist and a specialist dietitian, working as one team, with a written action plan you can hand to nursery the same week.
Why families choose us
- 01
A named paediatric allergist, not a generalist
A consultant paediatric allergist who sees FPIES routinely, working alongside a paediatric gastroenterologist and specialist dietitian.
- 02
A written FPIES action plan you can hand to nursery
Family-friendly and printable. What to give at home, when to call 999, and what A&E staff need to know about FPIES.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
What it is
Non-IgE food allergy - a different mechanism, a different clinic.
Non-IgE mediated food allergy is an immune reaction to a food that does not involve the IgE antibody. Skin prick and blood IgE tests come back negative. That does not mean it is not real.
In non-IgE food allergy, cellular immunity - not IgE - drives the reaction. Symptoms are delayed, from a couple of hours to a few days after the food is eaten, and they mostly involve the gut. Vomiting, diarrhoea, blood or mucus in the stool, poor growth. Because the mechanism is different, the tests you might expect for an immediate allergy are negative. The diagnosis is made from a careful history, sometimes an elimination-and-rechallenge, and, where useful, a supervised oral food challenge in a day-case unit.
This is a different pathway from the immediate, IgE-mediated food allergy that causes hives within minutes and can cause anaphylaxis. Both can occur in the same child, and both need their own written plan. In the non-IgE clinic, the team you meet - a paediatric allergist, a paediatric gastroenterologist and a specialist dietitian - is chosen for that reason.
Indicative pricing
What a private FPIES clinic costs in London.
Indicative ranges across our London partner units. Send the feeding diary and we come back with firm figures.
In short
Initial consultation with a paediatric allergist in London: £450–£850. A supervised FPIES challenge: £1,500–£2,500.
| Appointment | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial paediatric allergist consultation | £450–£850 | 45–60 min | Same visit |
| Joint allergist and paediatric gastro review | £650–£1,200 | 60–75 min | Same visit |
| Specialist paediatric dietitian appointment | £150–£280 | 45–60 min | Same visit |
| Supervised FPIES oral food challenge (day-case) | £1,500–£2,500 | 4–6 hours | Same day result |
| Follow-up consultation (allergist or gastro) | £250–£450 | 30 min | Same visit |
| Skin prick and specific IgE panel (to exclude IgE allergy) | £220–£420 | 30 min | 3–7 days |
Prices vary by hospital, by which consultant sees your child, and by whether a paediatric gastroenterologist joins. We come back with a firm quote within one working day.
The journey
From feeding diary to action plan - what happens, in order.
One team from the first message to the supervised food challenge, and the dietitian follow-up in between.
Phase 1 · Before the clinic
Concierge, off-stage for you
Phase 2 · On the day
Around an hour at the clinic
Phase 3 · After
Dietitian and challenge
- 01
Before
You send us the feeding diary
A short, confidential form. What your baby ate, how long after the meal they became unwell, what the reaction looked like, and any A&E notes if you have them.
- 02
Before
We come back with a plan
Within one working day. Which paediatric allergist fits, whether a paediatric gastroenterologist and dietitian should join, and whether a supervised oral food challenge is likely to be needed.
- 03
Before
We book the clinic
Usually within one to two weeks. Skin prick and specific IgE tests are arranged if immediate allergy also needs excluding.
- 04
On the day
The consultation
A careful history, a full examination, growth review, and a discussion with a specialist dietitian about safe substitutions and nutritional adequacy.
- 05
On the day
The FPIES action plan
A written, personalised plan for home, nursery and travel. Trigger foods listed, safe first foods listed, and a 999 script for acute reactions.
- 06
After
Dietitian follow-up
A follow-up review at four to six weeks to check growth, iron and calcium intake, and to widen safe foods carefully.
- 07
After
Supervised oral food challenge
At 12 to 18 months after the reaction, a day-case FPIES challenge with a cannula in situ to confirm the trigger has been outgrown.
Typical end-to-end: 1–2 weeks to first clinic. Dietitian review: 4–6 weeks. Supervised challenge: 12–18 months.
When to come
The patterns that bring parents in.
Non-IgE food allergy hides in plain sight. If any of the patterns below feel familiar, a specialist review will save months of guessing.
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Delayed profuse vomiting one to four hours after a feed
Repeated forceful vomiting, pallor and floppy tiredness one to four hours after a specific food - the classic acute FPIES pattern.
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Blood or mucus in a well baby's stool
A thriving, otherwise well breastfed or formula-fed baby with streaks of blood or mucus in the nappy - typical of FPIAP.
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Chronic diarrhoea and poor weight gain
Persistent loose stools, tummy distension and slow weight gain in a young baby - the picture of food protein-induced enteropathy.
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Normal skin prick and IgE tests despite clear reactions
A history of reproducible reactions to a food where the skin prick test and blood IgE come back negative - suggestive of non-IgE mechanism.
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Reaction on first or second exposure
A dramatic reaction the first or second time a food is introduced - often cow's milk, soya, rice, oats or egg.
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Repeat A&E visits for unexplained vomiting
Two or more admissions for sudden vomiting, dehydration or presumed sepsis where cultures were negative and the baby recovered quickly with fluids.
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Multiple food group involvement
A child who reacts to more than one unrelated food group - grains and proteins together - needs a specialist review, not another trial at home.
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Red flag: shock, drowsiness or unresponsive
Severe acute FPIES can cause hypovolaemic shock and needs 999 emergency care with IV fluids - a written plan matters.
The conditions we see
One clinic, several diagnoses.
Non-IgE food allergy is an umbrella. The clinic distinguishes between the conditions below, and the management is different for each.
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Acute FPIES
Delayed vomiting one to four hours after a trigger, often with pallor, lethargy and dehydration - occasionally shock. Common triggers are cow's milk, soya, rice, oats, chicken and egg. Onset is usually between three and twelve months.
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Chronic FPIES
Persistent vomiting, watery diarrhoea, poor weight gain and low blood proteins in a young infant on continuous cow's milk or soya formula. Symptoms improve within days of removing the trigger.
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FPIAP - allergic proctocolitis
A well, thriving baby with visible blood or mucus in the stool. Most often cow's milk protein, passed through breastmilk or given as formula. Benign, resolves with maternal exclusion or an extensively hydrolysed formula.
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Food protein-induced enteropathy
Chronic diarrhoea, malabsorption, failure to thrive and hypoproteinaemia in older infants. Cow's milk and soya are the usual culprits. Villous recovery happens over weeks once the food is removed.
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Eosinophilic gastrointestinal disorders
Overlap conditions like eosinophilic oesophagitis can share features. Endoscopy and biopsy are needed to confirm - a paediatric gastroenterologist is part of the team.
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IgE-mediated food allergy (for comparison)
Immediate hives, swelling or anaphylaxis within minutes of ingestion. Skin prick and blood IgE tests are positive. A different pathway, a different action plan, and adrenaline autoinjector training.
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Cow's milk protein allergy - mixed presentations
Some babies have both immediate and delayed features. The team assesses both, and the plan reflects both.
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Second-opinion review
A specialist review of hospital notes, feeding diary and any tests done so far - sometimes the answer is a careful home reintroduction, not another admission.
Where we send families in London
A small panel of paediatric allergy teams, we picked them.
Consultant paediatric allergists and gastroenterologists in London, working in units that regularly run supervised FPIES food challenges. Introductions are made privately, once we understand your child\'s pattern.
Great Ormond Street Hospital International Private
Tertiary paediatric allergy and gastroenterology with the full FPIES challenge pathway.
The Portland Hospital Paediatric Allergy
Central London paediatric allergy clinic with joint dietitian input.
HCA The Wellington Paediatric
North-west London day-case unit with paediatric anaesthetic and IV support.
Chelsea and Westminster Paediatric Private
West London paediatric allergy and gastroenterology, with rapid MDT access.
Selection criteria
How we choose every allergist in our London network.
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Consultant paediatric allergists on the GMC Specialist Register who see FPIES routinely
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Access to a paediatric gastroenterologist and specialist paediatric dietitian in the same clinic
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Day-case units that can run a supervised FPIES oral food challenge with cannula and IV fluids ready
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Written FPIES action plans in family-friendly language for home, nursery and travel
Acute care and ongoing management
What happens in a reaction, and what happens between them.
Acute FPIES is treated with IV fluids and ondansetron - not with adrenaline. Between reactions, strict avoidance, dietitian support and a written plan keep your child growing and your household calm.
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999 for an acute reaction
Acute FPIES can cause rapid dehydration and shock. If your baby is repeatedly vomiting, pale, floppy or unresponsive after a feed, call 999 - do not wait.
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IV fluids, fast
The mainstay of acute FPIES treatment is a rapid IV fluid bolus of normal saline (20 ml/kg). Most babies recover within a few hours once fluids are running.
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Ondansetron for the vomiting
A single IV or dispersible dose of ondansetron shortens the vomiting phase for children over six months. Included in your action plan for the A&E team.
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Corticosteroids for severe reactions
IV methylprednisolone is added for severe or shocked presentations to dampen the inflammatory response.
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Adrenaline is not the FPIES treatment
FPIES is not IgE-mediated. Adrenaline is only used if there are concurrent IgE features - hives, wheeze, tongue swelling - which is uncommon.
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Strict avoidance while you plan reintroduction
Between the reaction and the supervised challenge, the trigger is avoided completely. A dietitian helps you read labels, choose safe substitutes, and protect growth.
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Written action plan for nursery
A one-page plan naming your child, listing trigger foods, describing what a reaction looks like, and telling nursery staff exactly what to do - and what to say when the ambulance arrives.
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Nutritional adequacy matters
Removing cow's milk from a young child's diet can leave gaps in calcium, iodine, protein and energy. A paediatric dietitian keeps growth on track.
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Most children outgrow FPIES
Around 60 to 90 percent outgrow the trigger by three to four years of age, depending on the food. A supervised challenge confirms it - not a home trial.
Your clinic letter and action plan
Your paperwork in four parts. Read the last one first.
Whichever consultant you see, the clinic letter and the FPIES action plan follow the same shape.
A quiet reminder
Allergy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the plan before your nursery meeting, just ask.
- 01 History
Feeding diary and reaction pattern
Every food tried, the amount, the timing of symptoms, and the pattern of vomiting, pallor or diarrhoea. The single most important part of the diagnosis.
- 02 Tests
What was negative, and why it matters
A negative skin prick test and negative specific IgE do not exclude non-IgE food allergy - they support it. Sometimes patch testing is discussed for solid food FPIES, though it is not fully validated.
- 03 Diagnosis
The named trigger, and the mechanism
FPIES, FPIAP or enteropathy - the clinic names the condition, names the trigger, and explains what the immune mechanism means for treatment.
- 04 Plan
Action plan and reintroduction date
Read this first: the avoidance list, the written 999 script, the dietitian date, and when a supervised food challenge is planned.
Recognised by major UK insurers
Cover for paediatric allergy varies by insurer and by policy - usually funded when your child has clear symptoms and a GP referral. We confirm cover before booking.
Frequently asked
Everything parents ask us about FPIES.
Quick answers on outgrowing FPIES, blood tests, insurance, nursery plans, breastfeeding, and second triggers.
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At what age will my child outgrow FPIES?
Most children outgrow FPIES by three to four years of age. Cow's milk and soya FPIES tend to resolve earlier, often by two to three years. Rice and oat FPIES can take a little longer. The safest way to confirm resolution is a supervised oral food challenge with a cannula in place, usually 12 to 18 months after the last reaction.
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Is there a blood test that can diagnose FPIES?
No. There is no reliable blood test for FPIES. Skin prick tests and specific IgE blood tests are usually negative because FPIES is not IgE-mediated. Atopy patch testing has been studied for solid food FPIES but is not fully validated. The diagnosis is clinical, based on a careful history of the reaction pattern and, where needed, a supervised food challenge.
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Does private medical insurance cover this?
Most major UK insurers - Bupa, AXA Health, Vitality, Aviva, WPA and Cigna - cover paediatric allergy consultations, dietitian input and supervised food challenges when the child has clear symptoms and a GP referral. Cover for a supervised inpatient day-case FPIES challenge varies. We confirm your cover before we book anything.
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Can nursery still take my child if they have FPIES?
Yes. Nurseries are used to managing food allergies, including FPIES. The clinic provides a one-page written action plan naming your child, listing trigger foods, describing what a reaction looks like, and setting out step-by-step what nursery staff and the ambulance team need to do. We help you introduce the plan to the nursery manager.
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Is it safe to keep breastfeeding if my baby has FPIAP?
Yes. Breastfeeding is not stopped for FPIAP. The mother is asked to exclude the trigger from her own diet - most often cow's milk - and to take a calcium and vitamin D supplement. Symptoms usually settle within one to two weeks. A dietitian supports the exclusion so that your own nutrition is protected.
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My child reacted to a second, unrelated food - is that normal?
Around a third of children with FPIES react to more than one food. Common combinations are cow's milk plus soya, or rice plus oats. This is why introducing new solid foods is done carefully, ideally with dietitian guidance, and one food group at a time. If a second reaction happens, we bring the food challenge and dietitian review forward.
Related pathways
Looking for something else?
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Milk ladder reintroduction
Structured stepwise reintroduction of cow's milk protein.
Learn more -
Egg ladder reintroduction
Baked to loosely cooked, a stepwise plan for egg allergy.
Learn more -
Baby and toddler allergy assessment
A first specialist allergy review for babies and toddlers.
Learn more -
Oral food challenge
Supervised food challenge in a day-case unit.
Learn more -
Eosinophilic oesophagitis (EoE)
Chronic immune-mediated oesophageal disease in children and adults.
Learn more -
Anaphylaxis management and EpiPen training
For families whose child also has IgE-mediated allergy.
Learn more
Ready when you are
Send us the feeding diary. We come back within a working day.
One team, one plan, one written action sheet - for home, nursery and travel. We are independent, so the recommendation is impartial, and it costs you nothing.