希腊儿科人群食物蛋白诱导性肠炎综合征缓解模式。

Remission Patterns of Food Protein-Induced Enterocolitis Syndrome in a Greek Pediatric Population.

机构信息

Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece,

Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.

出版信息

Int Arch Allergy Immunol. 2019;180(2):113-119. doi: 10.1159/000500860. Epub 2019 Aug 7.

DOI:10.1159/000500860

PMID:31390649

Abstract

BACKGROUND

Data on the prevalence and clinical course of food protein-induced enterocolitis syndrome (FPIES) vary between populations and according to the culprit food.

OBJECTIVE

To evaluate the incidence, clinical characteristics, and remission patterns of FPIES among children in a Greek pediatric allergy referral center.

METHODS

We retrospectively studied children with acute FPIES. Data on age, sex, type of reaction, the implicated food, and oral food challenge (OFC) outcomes at baseline and upon reevaluation were analyzed.

RESULTS

Between October 2010 and March 2017, 72 (38 males) out of 15,114 subjects who had been referred to our department due to any reported allergic symptoms were diagnosed with acute FPIES. The most commonly implicated foods were cow's milk (CM) (45.8%), fish (34.7%), rice (9.7%), egg (6.9%), and chicken (2.8%). The mean age at diagnosis was 7.1/19.3/9.1/18.7/8.7 months for those with CM/fish/rice/egg/chicken FPIES, respectively. Sixty-nine OFCs were performed, of which 8 were diagnostic and 61 for tolerance evaluation. The type of culprit food was significantly associated with the outcome of the tolerance OFCs. OFCs to fish resulted positive at a significantly higher rate (12/22; 54.5%) than OFCs to CM (4/29; 13.7%), rice (1/5; 20%), egg (0/3; 0%), and chicken (0/2; 0%) (p = 0.01). The time period between diagnosis and tolerance acquisition was prolonged in the fish FPIES cases (74.8 months; 95% CI: 57.9-91.6) compared to that with other foods such as CM (20.7 months; 95% CI: 17.3-24.1), rice (31.8 months; 95% CI: 21.9-41.7), and egg (24.3 months; 95% CI: 10.7-37.9), as shown in a Kaplan-Meier analysis (log-rank, p < 0.001). When the fish FPIES children were assessed for tolerance, OFCs were significantly more often positive than in CM FPIES children (52 vs. 18.1%; p = 0.03), despite the fact that the children were challenged at an older age (fish: 70.4 months, 95% CI: 58.3-82.5, vs. CM: 26.57 months, 95% CI: 21.1-32, p < 0.001).

CONCLUSIONS

Acute FPIES had a low incidence in our population. CM and fish were the two most frequent elicitors. Significantly delayed presentation and prolonged remission was noted for FPIES caused by fish.

摘要

背景

食物蛋白诱导的肠病综合征（FPIES）的患病率和临床病程在不同人群和根据罪魁祸首食物而有所不同。

目的

评估希腊儿科过敏转介中心儿童中 FPIES 的发病率、临床特征和缓解模式。

方法

我们回顾性研究了患有急性 FPIES 的儿童。分析了年龄、性别、反应类型、罪魁祸首食物以及基线和重新评估时的口服食物挑战（OFC）结果的数据。

结果

在 2010 年 10 月至 2017 年 3 月期间，因任何报告的过敏症状而被转介到我们部门的 15114 名患者中，有 72 名（男性 38 名）被诊断为急性 FPIES。最常见的罪魁祸首食物是牛奶（CM）（45.8%）、鱼（34.7%）、米饭（9.7%）、鸡蛋（6.9%）和鸡肉（2.8%）。CM/fish/rice/egg/chicken FPIES 的平均诊断年龄分别为 7.1/19.3/9.1/18.7/8.7 个月。进行了 69 次 OFC，其中 8 次为诊断性，61 次为耐受性评估。罪魁祸首食物的类型与 OFC 的耐受性结果显著相关。鱼源性 FPIES 的 OFC 阳性率明显更高（12/22；54.5%），而 CM（4/29；13.7%）、米饭（1/5；20%）、鸡蛋（0/3；0%）和鸡肉（0/2；0%）（p=0.01）。与其他食物（如 CM[20.7 个月；95%CI：17.3-24.1]、米饭[31.8 个月；95%CI：21.9-41.7]和鸡蛋[24.3 个月；95%CI：10.7-37.9]）相比，鱼源性 FPIES 病例获得耐受性的时间明显延长（74.8 个月；95%CI：57.9-91.6），如 Kaplan-Meier 分析（对数秩，p<0.001）所示。当评估鱼源性 FPIES 儿童的耐受性时，OFC 阳性率明显高于 CM 源性 FPIES 儿童（52%比 18.1%；p=0.03），尽管儿童接受挑战的年龄更大（鱼：70.4 个月，95%CI：58.3-82.5，CM：26.57 个月，95%CI：21.1-32，p<0.001）。