Mane Shikha K, Bahna Sami L
Section of Allergy and Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Curr Opin Allergy Clin Immunol. 2014 Jun;14(3):217-21. doi: 10.1097/ACI.0000000000000052.
To raise awareness among healthcare providers about the clinical and laboratory findings in acute and chronic food protein-induced enterocolitis syndrome (FPIES).
FPIES can be caused by trivial exposure or rare foods.
FPIES is a non-IgE-mediated reaction that usually presents with acute severe repetitive vomiting and diarrhea associated with lethargy, pallor, dehydration, and even hypovolemic shock. Manifestations resolve usually within 24-48 h of elimination of the causative food. In chronic cases, symptoms may include persistent diarrhea, poor weight gain, failure to thrive, and improvement may take several days after the food elimination. In the acute cases, laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking about 6 h postingestion. Depending on the severity, metabolic acidosis and methemoglobinemia may occur. In chronic cases, anemia, hypoalbuminemia and eosinophilia may be seen. Radiologic evaluation or other procedures, such as endoscopy and gastric juice analysis may show nonspecific abnormal findings. The diagnosis is based on clinical manifestations. Further studies looking at the phenotypes of FPIES are needed to identify clinical subtypes, and to understand the predisposing factors for developing FPIES compared with immediate-type, IgE-mediated gastroenteropathies.
提高医疗服务提供者对急性和慢性食物蛋白诱导的小肠结肠炎综合征（FPIES）临床及实验室检查结果的认识。
FPIES可由少量接触或罕见食物引起。
FPIES是一种非IgE介导的反应，通常表现为急性严重反复呕吐和腹泻，并伴有嗜睡、面色苍白、脱水，甚至低血容量性休克。去除致病食物后，症状通常在24 - 48小时内缓解。在慢性病例中，症状可能包括持续性腹泻、体重增加缓慢、生长发育迟缓，去除食物后症状改善可能需要数天时间。在急性病例中，实验室检查可能显示血小板增多和中性粒细胞增多，在摄入食物后约6小时达到峰值。根据严重程度，可能会发生代谢性酸中毒和高铁血红蛋白血症。在慢性病例中，可能会出现贫血、低白蛋白血症和嗜酸性粒细胞增多。影像学评估或其他检查，如内镜检查和胃液分析，可能显示非特异性异常结果。诊断基于临床表现。需要进一步研究FPIES的表型，以确定临床亚型，并了解与速发型IgE介导的胃肠病相比，发生FPIES的易感因素。
