Food protein-induced enterocolitis syndrome caused by solid food proteins
Food protein-induced enterocolitis syndrome caused by solid food proteins
复制标题
DOI：
10.1542/peds.111.4.829
复制
发表时间：
2003-04-01
期刊：
影响因子：
8
通讯作者：
Sicherer, SH
中科院分区：
文献类型：
--
作者：
Nowak-Wegrzyn, A;Sampson, HA;Sicherer, SH
背景。婴儿食物蛋白诱发的小肠结肠炎综合征 (FPIES) 是一种严重的细胞介导的胃肠道食物过敏症，通常由牛奶或大豆引起。固体食物很少被认为是一个原因。客观。描述固体食物引起的 FPIES 的临床特征和自然史。方法。确定由固体食物引起的 FPIES 患者，并将其临床病程与同期由牛奶和/或大豆引起的 FPIES 对照组进行比较。结果。确定了 14 名婴儿因谷物（大米、燕麦和大麦）、蔬菜（红薯、南瓜、四季豆、豌豆）或家禽（鸡肉和火鸡）而患有 FPIES。症状是经典 FPIES 的典型症状，包括延迟（中位：2 小时）呕吐、腹泻和嗜睡/脱水。 11 名婴儿 (78%) 对 >1 种食物蛋白质有反应，其中 7 名婴儿 (50%) 对 >1 种谷物有反应。所有患有固体食物 FPIES 的患者中，九名 (64%) 也食用牛奶和/或大豆 FPIES。 79% 的患者最初表现很严重，促使进行脓毒症评估（57%）并因脱水或休克住院（64%）。 FPIES 的诊断延迟，中位数为 2 次反应（范围：2-5）。确定了 30 名具有典型牛奶和/或大豆 FPIES 的患者进行比较。总体而言，44 名患有 FPIES 的婴儿中有 48% 对 >1 种食物蛋白有反应，并且在食用固体食物或大豆引起的 FPIES 的婴儿中，多种食物过敏的风险接近 80%。没有患者因母乳喂养期间母亲摄入的食物而出现 FPIES，除非直接给婴儿喂食致病食物。结论。谷物、蔬菜和家禽肉通常被认为具有低过敏性，因此在评估 FPIES 时必须予以考虑，特别是对于之前诊断为牛奶或大豆引起 FPIES 的婴儿，以及作为纯母乳喂养患者的初始原因。患有 FPIES 的婴儿在明显的免疫易感期期间面临多种饮食蛋白质过敏的风险。儿科医生应在休克和败血症的鉴别诊断中考虑 FPIES。
Background. Infantile food protein-induced enterocolitis syndrome (FPIES) is a severe, cell-mediated gastrointestinal food hypersensitivity typically provoked by cow's milk or soy. Solid foods are rarely considered a cause.Objective. To describe the clinical characteristics and natural history of FPIES provoked by solid foods.Methods. Patients with FPIES induced by solid foods were identified and their clinical course compared with a control group with FPIES caused by cow's milk and/or soy evaluated over the same time period.Results. Fourteen infants with FPIES caused by grains (rice, oat, and barley), vegetables (sweet potato, squash, string beans, peas), or poultry (chicken and turkey) were identified. Symptoms were typical of classical FPIES with delayed (median: 2 hours) onset of vomiting, diarrhea, and lethargy/dehydration. Eleven infants (78%) reacted to >1 food protein, including 7 (50%) that reacted to >1 grain. Nine (64%) of all patients with solid food FPIES also had cow's milk and/or soy-FPIES. Initial presentation was severe in 79% of the patients, prompting sepsis evaluations (57%) and hospitalization (64%) for dehydration or shock. The diagnosis of FPIES was delayed, after a median of 2 reactions (range: 2-5). Thirty patients with typical cow's milk- and/or soy-FPIES were identified for comparison. Overall, 48% of the 44 infants with FPIES were reactive to >1 food protein, and the risk for multiple food hypersensitivity approached 80% in the infants with solid food or soy-induced FPIES. None of the patients developed FPIES to maternally ingested foods while breastfeeding unless the causal food was fed directly to the infant.Conclusions. Cereals, vegetables, and poultry meats, typically regarded as of low allergenic potential, must be considered in the evaluation of FPIES, particularly in infants previously diagnosed with FPIES to cow's milk or soy, and as an initial cause in patients who have been exclusively breastfed. Infants with FPIES are at risk for multiple dietary protein hypersensitivities during an apparent period of immunologic susceptibility. Pediatricians should consider FPIES in the differential diagnosis of shock and sepsis.