Food Protein-Induced Enterocolitis Syndrome: 16-Year Experience
Food Protein-Induced Enterocolitis Syndrome: 16-Year Experience
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DOI：
10.1542/peds.2008-2029
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发表时间：
2009-03-01
期刊：
影响因子：
8
通讯作者：
Kemp, Andrew S.
中科院分区：
文献类型：
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作者：
Mehr, Sam;Kakakios, Alyson;Kemp, Andrew S.
OBJECTIVE.目的是研究急性食物蛋白诱导的小肠结肠炎综合征儿童的人口统计学特征、致病食物、临床特征、治疗和结局。这是一项回顾性研究，研究对象是在Westmead（澳大利亚悉尼）儿童医院就诊超过16年的食物蛋白诱导的小肠结肠炎综合征儿童。35名儿童经历了66次食物蛋白诱导的小肠结肠炎综合征。初次就诊时的平均年龄为5.5个月。儿童经常在做出正确诊断之前经历多次发作。29名儿童对1种食物有反应，6名儿童对2种食物有反应。35名儿童的致病食物为大米（n = 14）、大豆（n = 12）、牛奶（n = 7）、蔬菜和水果（n = 3）、肉类（n = 2）、燕麦（n = 2）和鱼类（n = 1）。在66次发作中，呕吐是最常见的临床特征（100%），其次是嗜睡（85%）、苍白（67%）和腹泻（24%）。63%的事件记录了500 x 109个细胞/L的温度和血细胞计数结果。在19名因最初反应而到急诊室就诊的儿童中，只有2名儿童出院时诊断正确。对食物蛋白诱导的小肠结肠炎综合征发作进行额外的调查是常见的，34%的患者接受腹部成像，28%接受脓毒症评估，22%接受手术咨询。预后良好，到3岁时，2种最常见的食物触发因素（即大米和大豆）的解决率很高。结论。食物蛋白诱导的小肠结肠炎综合征的儿童误诊和延误诊断是常见的，导致许多儿童接受不必要的，往往是痛苦的调查。体温下降和血小板增多是该综合征的额外特征。儿科2009; 123：e459-e464
OBJECTIVE. The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced enterocolitis syndrome.METHODS. This was a retrospective study of children with food protein-induced enterocolitis syndrome who presented to the Children's Hospital at Westmead ( Sydney, Australia) over 16 years.RESULTS. Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of 500 x 109 cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age.CONCLUSIONS. Misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome. Pediatrics 2009; 123: e459-e464