Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine, One Gustave G. Levy Place, Box 1198, New York, NY, 10029, USA.
Clin Rev Allergy Immunol. 2019 Oct;57(2):261-271. doi: 10.1007/s12016-018-8722-z.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that has been well-characterized clinically, yet it is still poorly understood. Acute FPIES is characterized by vomiting 1-4 h and/or diarrhea within 24 h after ingestion of a culprit food. Chronic FPIES is the result of chronic exposure to an offending food that can result in chronic watery diarrhea, intermittent vomiting, and failure to thrive. FPIES typically presents in infancy and self-resolves by school age in most patients. Adult-onset FPIES is rare, but it has been reported. Cow's milk and soy are the most common triggering foods in infants in the US, and as solids are introduced in the diet, FPIES reactions to grains (rice, oat) increase in prevalence. Variability in common trigger foods exists depending on the geographical origin-for example, fish is a frequent trigger in Spanish and Italian patients. Heavy reliance on a detailed history is required for the diagnosis as physical exam findings, laboratory tests, and/or imaging studies are suggestive and not specific for FPIES. Oral food challenges remain the gold standard for confirming diagnosis, and the challenge protocol may be for an individual depending on risk of reaction, prior reaction severity, and positive-specific IgE status. The recent development of diagnostic criteria in 2017 will serve to increase recognition of the disorder and allow for early implementation of management strategies. Acute management during reactions includes IV hydration, anti-emetics, and IV corticosteroids. Reaction prevention strategies include strict food avoidance until the physician deems a food reintroduction challenge clinically appropriate. Future efforts in FPIES research should be aimed at elucidating the underlying disease mechanisms and possible treatment targets.
食物蛋白诱导的肠病综合征（FPIES）是一种非 IgE 介导的食物过敏，其临床特征已得到很好的描述，但仍知之甚少。急性 FPIES 的特征是在摄入罪魁祸首食物后 1-4 小时内出现呕吐和/或 24 小时内出现腹泻。慢性 FPIES 是由于长期接触引发食物，导致慢性水样腹泻、间歇性呕吐和生长不良。FPIES 通常在婴儿期发病，大多数患者在上学年龄时自行缓解。成人发病的 FPIES 很少见，但已有报道。牛奶和大豆是美国婴儿中最常见的引发食物，随着饮食中引入固体食物，对谷物（大米、燕麦）的 FPIES 反应的患病率增加。常见引发食物的变异性因地理位置而异，例如，鱼类是西班牙和意大利患者的常见引发食物。由于体格检查结果、实验室检查和/或影像学研究提示而非特异性，因此需要详细的病史来诊断。口服食物挑战仍然是确诊的金标准，挑战方案可能因个体而异，取决于反应风险、既往反应严重程度和阳性特异性 IgE 状态。2017 年新制定的诊断标准将有助于提高对该疾病的认识，并尽早实施管理策略。反应期间的急性管理包括静脉补液、止吐药和静脉皮质类固醇。预防反应的策略包括在医生认为临床适当的情况下严格避免食用该食物，直到重新引入食物挑战。未来在 FPIES 研究中的努力应旨在阐明潜在的疾病机制和可能的治疗靶点。
