背景:食物蛋白诱导的小肠结肠炎综合征(FPIES)是一种延迟,非IgE介导的食物过敏。这种综合症曾经被认为是罕见的,但是新兴的文献表明,随着更多的食物被牵连,发病率也在增加。此外,随着花生早期引进指南的出台,花生诱导的FPIES在澳大利亚和美国似乎正在增加。尽管大多数患者在出生后的第一年就被诊断出患有FPIES,最常见的食物触发牛奶或大豆,与此经典演示相比,还存在其他表型。在这个案例报告中,我们介绍了一名3岁时出现迟发性急性FPIES的核桃患者。
方法:我们描述了一个12岁男孩反复发作反复呕吐的FPIES病例,这始于3岁,每次食用核桃后。妈妈没有故意喂养(或避免)核桃和/或山核桃的历史。她还描述了松子和澳洲坚果的可能反应。他接受了核桃口服食物挑战的评估,引发急性FPIES发作。他在摄入后2小时出现呕吐,苍白,嗜睡,并需要急诊就诊止吐药物和口服补液治疗。他在治疗上有所改善,现在避免了腰果,开心果,榛子,核桃,山核桃,松子,和澳洲坚果.
结论:本病例报告增加了关于FPIES中罪魁祸首食物过敏原的有限文献。我们提出了一种由核桃摄入引发的急性FPIES。诊断,常见的食物触发因素,并描述了FPIES的自然史。仍然缺乏关于FPIES自然历史的信息,特别是针对不常见的食物触发因素和超过婴儿期的FPIES。
BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is a delayed, non-IgE-mediated food allergy. This syndrome was once thought to be rare, but emerging literature suggests an increasing incidence along with more foods being implicated. Also, with the introduction of guidelines on early peanut introduction, peanut-induced FPIES seems to be increasing in Australia and USA. Although most patients are diagnosed with FPIES within the first year of life, most commonly with food triggers to cow\'s milk or soy, other phenotypes exist in comparison to this classic presentation. In this case report, we present a patient with late onset of acute FPIES at age 3 to walnut.
METHODS: We describe a case of FPIES in a 12-year-old boy who had recurrent episodes of repetitive emesis, that began at age 3, each time after consuming walnuts. Mom does not give a history of intentional feeding (or avoidance) of walnut and/ or pecans. She also described possible reactions with pine nuts and macadamia. He was assessed with an oral food challenge to walnut, which triggered an episode of acute FPIES. He developed vomiting with onset 2 h post-ingestion, pallor, lethargy, and required an emergency department visit for anti-emetic medications and oral rehydration therapy. He improved on the therapy and now avoids cashew, pistachio, hazelnuts, walnuts, pecans, pine nuts, and macadamia nuts.
CONCLUSIONS: This case report adds to the limited literature that exists on culprit food allergens in FPIES. We present an acute FPIES triggered by the ingestion of walnuts. The diagnosis, common food triggers, and natural history of FPIES are described. There remains a lack of information on the natural history of FPIES, especially towards uncommon food triggers and on FPIES that present beyond infancy.