背景:患有食物蛋白诱导的小肠结肠炎综合征(FPIES)的成年人在食用海鲜后通常会出现严重的腹部症状。然而,迄今为止,尚未对成人FPIES患者的食物消除策略进行研究.
方法:我们通过电话访谈对不吃海鲜的成年人进行了回顾性队列研究,基于González等人报告的成人FPIES诊断标准。我们比较了临床资料,腹部症状,FPIES和即时型食物过敏(IgE介导的FA)患者之间的致病性海鲜。我们还分析了成人FPIES患者海产品的详细摄入状况。
结果:117名海鲜过敏成年人中有22名(18.8%)被诊断为FPIES。与IgE介导的FA患者相比,FPIES患者发病年龄较大,更多先前存在的胃肠道和特应性疾病,更多剧集,症状的潜伏期和持续时间更长,更恶心,腹胀,严重的腹痛,更频繁的呕吐和腹泻。特别是,腹胀-反映肠水肿和管腔积液-可能是成人FPIES最独特的特征性症状(p<0.001).双壳类动物,尤其是牡蛎,是FPIES的最常见原因。引人注目的是,摄入状况分析显示,许多FPIES患者可以安全摄入平均92.6%的海鲜物种,而不是致病物种。
结论:FPIES和IgE介导的FA之间存在许多差异,这可能反映了潜在免疫机制的差异。尽管海鲜FPIES不太可能引起耐受性,许多患者在发病后很长一段时间内可以摄取各种各样的海鲜。
BACKGROUND: Adults with food-protein-induced enterocolitis syndrome (FPIES) often develop severe abdominal symptoms after eating seafood. However, no investigation of a food elimination strategy for adult FPIES patients has been performed to date.
METHODS: We conducted a retrospective cohort study of seafood-avoidant adults by telephone interview, based on the diagnostic criteria for adult FPIES reported by González et al. We compared the clinical profiles, abdominal symptoms, and causative seafoods between FPIES and immediate-type food allergy (IgE-mediated FA) patients. We also profiled the detailed intake-status of seafoods in adult FPIES patients.
RESULTS: Twenty-two (18.8 %) of 117 adults with seafood-allergy were diagnosed with FPIES. Compared with the IgE-mediated FA patients, FPIES patients had an older age of onset, more pre-existing gastrointestinal and atopic diseases, more episodes, longer latency and duration of symptoms, more nausea, abdominal distention, and severe abdominal pain, and more frequent vomiting and diarrhea. In particular, abdominal distention-reflecting intestinal edema and luminal fluid retention-may be the most distinctive characteristic symptom in adult FPIES (p < 0.001). Bivalves, especially oysters, were the most common cause of FPIES. Strikingly, intake-status profiling revealed that many FPIES patients can safely ingest an average of 92.6 % of seafood species other than the causative species.
CONCLUSIONS: There are many differentiators between FPIES and IgE-mediated FA, which may reflect differences in the underlying immunological mechanisms. Although seafood FPIES is unlikely to induce tolerance, many patients can ingest a wide variety of seafood species after a long period from onset.