Ankara Children's Hematology and Oncology Training and Research Hospital, Health Sciences University, Ankara.
Dr. Behçet Uz Children Training and Research Hospital, Health Sciences University, İzmir.
J Pediatr Gastroenterol Nutr. 2020 May;70(5):574-579. doi: 10.1097/MPG.0000000000002629.
Continued progress in our understanding of the food protein-induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established.
Infants who were admitted with rectal bleeding and had a diagnosis of food protein-induced allergic proctocolitis in 5 different allergy or gastroenterology outpatient clinics were enrolled. Clinical features, laboratory tests, and prognosis were evaluated. Risk factors for persistent course were determined by logistic regression analyses.
Among the 257 infants, 50.2% (n = 129) were girls and cow's milk (99.2%) was the most common trigger. Twenty-four percent of the patients had multiple food allergies and had more common antibiotic use (41.9% vs 11.8%), atopic dermatitis (21% vs 10.2%), wheezing (11.3% vs 1.5%), colic (33.8% vs 11.2%), and IgE sensitization (50% vs 13.5%) compared to the single-food allergic group (P < 0.001, P = 0.025, P = 0.003, P < 0.001, respectively). In multivariate logistic regression analysis, presence of colic (odds ratio [OR]: 5.128, 95% confidence interval [CI]: 1.926-13.655, P = 0.001), IgE sensitization (OR: 3.964, 95% CI: 1.424-11.034, P = 0.008), and having allergy to multiple foods (OR: 3.679, 95% CI: 1.278-10.593, P = 0.001] were found to be risk factors for continuing disease after 1 year of age.
Although most children achieve tolerance at 1 year of age, IgE sensitization, allergy to multiple foods, and presence of colic were risk factors for persistent course and late tolerance. In this context, these children may require more close and extended follow-up.
我们对食物蛋白诱导的直肠结肠炎（FPIAP）的理解不断深入，这将为诊断测试和治疗方法的发展提供帮助。本研究旨在通过对大量患者进行研究，明确该疾病的临床特征和自然病程。此外，我们还研究了持续性疾病的预测风险因素，因为目前尚未确定影响参数。
在 5 家不同的过敏或胃肠病门诊，我们招募了因直肠出血并被诊断为食物蛋白诱导的直肠结肠炎的婴儿。评估临床特征、实验室检查和预后。通过逻辑回归分析确定持续性疾病的危险因素。
在 257 名婴儿中，50.2%（n=129）为女孩，最常见的触发因素是牛奶（99.2%）。24%的患者有多种食物过敏，更常见使用抗生素（41.9%比 11.8%）、特应性皮炎（21%比 10.2%）、喘息（11.3%比 1.5%）、绞痛（33.8%比 11.2%）和 IgE 致敏（50%比 13.5%），与单一食物过敏组相比（P<0.001、P=0.025、P=0.003、P<0.001，分别）。在多变量逻辑回归分析中，存在绞痛（比值比[OR]：5.128，95%置信区间[CI]：1.926-13.655，P=0.001）、IgE 致敏（OR：3.964，95%CI：1.424-11.034，P=0.008）和对多种食物过敏（OR：3.679，95%CI：1.278-10.593，P=0.001）被发现是 1 岁后持续疾病的危险因素。
尽管大多数儿童在 1 岁时达到耐受，但 IgE 致敏、对多种食物过敏和绞痛的存在是持续性疾病和迟发性耐受的危险因素。在这种情况下，这些儿童可能需要更密切和更广泛的随访。
