非IgE介导的食物过敏是一组以肠道亚急性或慢性炎症过程为特征的疾病。不同于IgE介导的食物过敏可能导致多器官系统过敏反应,非IgE介导的食物过敏主要影响胃肠道。这篇综述概述了临床表现,流行病学,病理生理学,和管理非IgE介导的食物过敏。本综述使用PubMed数据库对选定的非IgE介导的食物过敏进行了最新的文献检索,直至当年(2021年)。审查的疾病包括食物蛋白诱导的小肠结肠炎综合征(FPIES),食物蛋白肠病(FPE),食物蛋白诱导的过敏性直肠结肠炎(FPIAP),和嗜酸性粒细胞性胃肠道疾病(EGIDs),如嗜酸性粒细胞性食管炎(EoE)。虽然在理解FPIES方面取得了广泛的进展,FPIAP,FPE,还有EoE,这些食物过敏的病理生理学需要更多的信息。它们之间的相似之处包括先天免疫的参与,T淋巴细胞过程,随着炎性细胞的出现和相关的组织学变化,在细胞水平上改变肠腔,和特定的细胞因子谱表明食物特异性,T细胞,和免疫介导的反应。虽然FPIES和FPIAP通常在儿童早期解决,EGID通常不会。新兴的EoE新疗法提供了更多治疗选择的希望。进一步的研究确定的免疫发病机制,相关的生物标志物,需要宽容机制来为预防提供信息,诊断和管理。
Non-IgE-mediated food allergies are a group of disorders characterized by subacute or chronic inflammatory processes in the gut. Unlike IgE mediated food allergies that may result in multi-organ system anaphylaxis, the non-IgE mediated food allergies primarily affect the gastrointestinal tract. This review outlines the clinical manifestations, epidemiology, pathophysiology, and management of non-IgE-mediated food allergies. An updated literature search of selected non-IgE-mediated food allergies was conducted for this review using PubMed database to the current year (2021). Reviewed disorders include food protein-induced enterocolitis syndrome (FPIES), food-protein enteropathy (FPE), food protein-induced allergic proctocolitis (
FPIAP), and eosinophilic gastrointestinal disorders (EGIDs) such as eosinophilic esophagitis (EoE). While extensive gains have been made in understanding FPIES,
FPIAP, FPE, and EoE, more information is needed on the pathophysiology of these food allergies. Similarities among them include involvement of innate immunity, T-lymphocyte processes, alteration of the intestinal lumen at the cellular level with the appearance of inflammatory cells and associated histologic changes, and specific cytokine profiles suggesting food-specific, T-cell, and immune-mediated responses. While FPIES and
FPIAP typically resolve in early childhood, EGIDs typically do not. Emerging new therapies for EoE offer promise of additional treatment options. Further studies identifying the immunopathogenesis, associated biomarkers, and mechanisms of tolerance are needed to inform prevention, diagnosis and management.