Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, New South Wales, Australia.
J Allergy Clin Immunol Pract. 2019 Feb;7(2):471-478.e3. doi: 10.1016/j.jaip.2018.10.020. Epub 2018 Oct 25.
Food protein-induced enterocolitis syndrome (FPIES) is frequently misdiagnosed and subject to diagnostic delay. Profuse vomiting, the cardinal feature of acute FPIES, may occur in more common pediatric disorders such as gastroenteritis and sepsis.
We sought to determine differentiating features at acute presentation between FPIES, gastroenteritis, and sepsis in young children presenting to an emergency department (ED) with profuse vomiting.
We conducted a retrospective case-control study of children aged 6 months to 4 years with a diagnosis of acute FPIES who had presented to ED and compared the clinical features, vital signs, and routine laboratory studies of this cohort to similarly aged children presenting to ED with vomiting diagnosed with bacterial/viral gastroenteritis or bacterial sepsis.
A total of 181 acute FPIES ED presentations were compared with 55 gastroenteritis and 36 bacterial sepsis ED presentations. Children with FPIES were more likely to present with lethargy, floppiness, and pallor. Compared with children with FPIES, children with sepsis were likely to present with fever, tachycardia, tachypnea, and diarrhea, whereas those with gastroenteritis were likely to present with fever, diarrhea, and blood in stools. Normal C-reactive protein (CRP), leucocytosis, lymphocytosis, thrombocytosis, low MPV, and an elevated albumin/globulin ratio were more commonly seen in FPIES than in sepsis or gastroenteritis. No other clinical or laboratory markers examined reliably distinguished between the 3 disease groups.
In the young vomiting child, lethargy, floppiness, pallor without fever, and normal CRP should alert clinicians to a possible diagnosis of FPIES. In contrast, a highly elevated CRP is not a feature of FPIES, and in such cases an alternative diagnosis must be considered.
食物蛋白诱导的小肠结肠炎综合征（FPIES）常被误诊，且诊断时间延迟。大量呕吐是急性 FPIES 的主要特征，但也可能发生在更常见的儿科疾病中，如胃肠炎和败血症。
我们旨在确定在因大量呕吐而就诊于急诊科的幼儿中，急性 FPIES 与胃肠炎和败血症在急性发作时的表现有何不同。
我们进行了一项回顾性病例对照研究，纳入了年龄在 6 个月至 4 岁之间、被诊断为急性 FPIES 并曾就诊于急诊科的患儿，并将该队列的临床特征、生命体征和常规实验室研究与同样年龄因呕吐而就诊于急诊科、被诊断为细菌性/病毒性胃肠炎或细菌性败血症的患儿进行了比较。
共比较了 181 例急性 FPIES 急诊科就诊、55 例胃肠炎和 36 例细菌性败血症急诊科就诊患儿的临床资料。FPIES 患儿更有可能出现嗜睡、软弱无力和苍白。与 FPIES 患儿相比，败血症患儿更有可能出现发热、心动过速、呼吸急促和腹泻，而胃肠炎患儿更有可能出现发热、腹泻和粪便中有血。FPIES 患儿的 C 反应蛋白（CRP）正常、白细胞增多、淋巴细胞增多、血小板增多、平均血小板体积（MPV）降低和白蛋白/球蛋白比值升高的比例高于败血症或胃肠炎患儿。未发现其他临床或实验室标志物能可靠地区分这 3 种疾病。
在年幼的呕吐患儿中，无发热的嗜睡、软弱无力和苍白，以及正常的 CRP 应引起临床医生对 FPIES 的警惕。相比之下，CRP 显著升高并非 FPIES 的特征，在这种情况下必须考虑其他诊断。
