■食物蛋白诱导的小肠结肠炎综合征(FPIES)是一种非免疫球蛋白E(IgE)细胞介导的食物过敏,可引起严重症状,被认为是过敏性紧急情况。
■描述FPIES流行病学并评估诊断和管理方法。
■自2017年第一份国际FPIES共识指南发布以来,在同行评审期刊上发表的相关文章的回顾。
■FPIES估计会影响美国0.51-0.9%的儿童和0.22%的成年人。它通常表现为持久的,抛射性呕吐,发生在摄入罪魁祸首食物的1-4小时内,有时在摄入后24小时内腹泻。在15-20%的严重病例中,患者进入低血容量或分布性休克。在慢性FPIES中,婴儿可能无法茁壮成长和体重减轻。最常见的诱因包括牛奶,燕麦,大米,和鳄梨,鸡蛋和花生的报道更频繁。其他常见的水果和蔬菜触发器的例子包括香蕉,苹果,还有红薯.FPIES可以分为急性,慢性,成年发病,或非典型亚型。FPIES与IgE介导的食物过敏的共病特应性疾病有关,特应性皮炎,哮喘,过敏性鼻炎,和嗜酸性粒细胞性食管炎.婴儿FPIES的自然历史通常是有利的,鱼FPIES除外。成人海鲜FPIES在3-5年内的分辨率较低。正确识别FPIES可能是具有挑战性的,因为没有用于诊断的特定生物标志物,并且症状的星座可能模仿感染性肠炎或败血症的症状。管理依赖于饮食食物的避免,对口服食物挑战的耐受性的定期重新评估,补液和止吐昂丹司琼急性反应的处理。尽管FPIES的病理生理学仍然知之甚少,潜在的机制,如细胞因子释放,白细胞活化,胃肠道粘膜屏障功能受损可能是进一步研究的基石。
■预防,实验室诊断测试,加快耐受性发展的战略是FPIES中迫切需要满足的需求。
UNASSIGNED: Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE) cell mediated food allergy that can cause severe symptoms and is considered an allergic emergency.
UNASSIGNED: To describe FPIES epidemiology and appraise the approach to diagnosis and management.
UNASSIGNED: A review of the relevant articles published in the peer-reviewed journals since the publication of the First International FPIES Consensus Guidelines in 2017.
UNASSIGNED: FPIES is estimated to affect 0.51-0.9% of children and 0.22% of adults in the United States. It typically presents with protracted, projectile vomiting, which occurs within 1-4 hours of ingesting culprit foods, sometimes followed by diarrhea within 24 hours of ingestion. In ∼15-20% of severe cases, patients go into hypovolemic or distributive shock. In chronic FPIES, infants may have failure to thrive and weight loss. The most common triggers include cow\'s milk, oat, rice, and avocado, with egg and peanut being more frequently reported. Examples of other common fruit and vegetable triggers include banana, apple, and sweet potato. FPIES can be classified into acute, chronic, adult-onset, or atypical subtypes. FPIES is associated with comorbid atopic conditions of IgE-mediated food allergy, atopic dermatitis, asthma, allergic rhinitis, and eosinophilic esophagitis. The natural history of infantile FPIES is generally favorable, with the exception of fish FPIES. Seafood FPIES in adults has low rates of resolution over 3-5 years. Correctly identifying FPIES can be challenging because there are no specific biomarkers for diagnosis and the constellation of symptoms may mimic those of infectious enteritis or sepsis. Management relies on dietary food avoidance, periodic re-evaluations for tolerance with oral food challenges, and management of acute reactions with rehydration and antiemetic ondansetron. Although the pathophysiology of FPIES remains poorly understood, underlying mechanisms such as cytokine release, leukocyte activation, and impaired gastrointestinal mucosal barrier function may act as cornerstones for further research.
UNASSIGNED: Prevention, laboratory diagnostic testing, and strategies to accelerate tolerance development are urgent unmet needs in FPIES.